Provider Demographics
NPI:1518062678
Name:STONE, MARK A (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:STONE
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 1:333 N LANTANA ST
Mailing Address - Street 2:STE. 114
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-9010
Mailing Address - Country:US
Mailing Address - Phone:805-987-1555
Mailing Address - Fax:805-389-9695
Practice Address - Street 1:333 N LANTANA ST
Practice Address - Street 2:STE. 114
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-9010
Practice Address - Country:US
Practice Address - Phone:805-987-1555
Practice Address - Fax:805-389-9695
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0162150OtherBLUE SHIELD
CA016215Medicare UPIN
CADC0162150OtherBLUE SHIELD