Provider Demographics
NPI:1548386592
Name:MATTOON, MARK JOSEPH SR (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:MATTOON
Suffix:SR
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 1:251 JEANELL DR
Mailing Address - Street 2:SUITE #5
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-2148
Mailing Address - Country:US
Mailing Address - Phone:775-882-1068
Mailing Address - Fax:775-882-5131
Practice Address - Street 1:251 JEANELL DR
Practice Address - Street 2:SUITE #5
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-2148
Practice Address - Country:US
Practice Address - Phone:775-882-1068
Practice Address - Fax:775-882-5131
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-262111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic