Provider Demographics
NPI:1518188713
Name:HADDOCK, MARK ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:HADDOCK
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 1:1225 A NORTHWAY
Mailing Address - Street 2:PO BOX 2539
Mailing Address - City:DARIEN
Mailing Address - State:GA
Mailing Address - Zip Code:31305-2539
Mailing Address - Country:US
Mailing Address - Phone:912-437-2663
Mailing Address - Fax:
Practice Address - Street 1:1225 A NORTHWAY
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:GA
Practice Address - Zip Code:31305-2539
Practice Address - Country:US
Practice Address - Phone:912-437-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor