Provider Demographics
NPI:1548795198
Name:MAHAND, MARK C
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:MAHAND
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:ANTONIA
Other - Middle Name:S
Other - Last Name:MAHAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:244 JOHNSON DR
Mailing Address - Street 2:502 N BARRON
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-1902
Mailing Address - Country:US
Mailing Address - Phone:903-284-1377
Mailing Address - Fax:
Practice Address - Street 1:244 JOHNSON DR
Practice Address - Street 2:502 N BARRON
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1902
Practice Address - Country:US
Practice Address - Phone:903-284-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor