Provider Demographics
NPI:1558437558
Name:COCHRAN, MARK JAMES (DC,ND)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:DC,ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 S CEDAR AVE
Mailing Address - Street 2:2
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4204
Mailing Address - Country:US
Mailing Address - Phone:507-451-9221
Mailing Address - Fax:507-451-9221
Practice Address - Street 1:1828 S CEDAR AVE
Practice Address - Street 2:2
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4204
Practice Address - Country:US
Practice Address - Phone:507-451-9221
Practice Address - Fax:507-451-9221
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN67Q00COOtherBCBS
MN67Q00COOtherBCBS