Provider Demographics
NPI:1578568606
Name:SOMBERG, MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SOMBERG
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 1:5348 TOPANGA CANYON BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1739
Mailing Address - Country:US
Mailing Address - Phone:818-883-5880
Mailing Address - Fax:818-883-9117
Practice Address - Street 1:5348 TOPANGA CANYON BLVD
Practice Address - Street 2:STE 105
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1739
Practice Address - Country:US
Practice Address - Phone:818-883-5880
Practice Address - Fax:818-883-9117
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2012-02-28
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-18
Provider Licenses
StateLicense IDTaxonomies
CADC11818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC11818Medicare ID - Type Unspecified