Provider Demographics
NPI:1508862251
Name:SACK, MARK SCANLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SCANLAN
Last Name:SACK
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 1:228B MORGANTON BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5219
Mailing Address - Country:US
Mailing Address - Phone:828-754-8181
Mailing Address - Fax:828-754-8140
Practice Address - Street 1:228B MORGANTON BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5219
Practice Address - Country:US
Practice Address - Phone:828-754-8181
Practice Address - Fax:828-754-8140
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
NC2463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890828QMedicaid
NC2451561BMedicare ID - Type Unspecified
NC890828QMedicaid