Provider Demographics
NPI:1518974914
Name:UNGERANK, MARK LUDEAN (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LUDEAN
Last Name:UNGERANK
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 1:1 MEDICAL PLZ
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2918
Mailing Address - Country:US
Mailing Address - Phone:870-425-2515
Mailing Address - Fax:870-425-2710
Practice Address - Street 1:1 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2918
Practice Address - Country:US
Practice Address - Phone:870-425-2515
Practice Address - Fax:870-425-2710
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101032718Medicaid
ART20731Medicare UPIN
AR59910Medicare ID - Type Unspecified