Provider Demographics
NPI:1497878698
Name:BLANCK, MARK E (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:BLANCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 561111
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6111
Mailing Address - Country:US
Mailing Address - Phone:469-525-2393
Mailing Address - Fax:469-633-1505
Practice Address - Street 1:7010 PRESTON RD STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5871
Practice Address - Country:US
Practice Address - Phone:469-525-2393
Practice Address - Fax:469-633-1505
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor