Provider Demographics
NPI:1588857510
Name:PELLER, MARK DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:PELLER
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 1:3204 TOWER OAKS BLVD
Mailing Address - Street 2:SUITE105
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4250
Mailing Address - Country:US
Mailing Address - Phone:301-230-2001
Mailing Address - Fax:301-230-2002
Practice Address - Street 1:3204 TOWER OAKS BLVD
Practice Address - Street 2:SUITE105
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4250
Practice Address - Country:US
Practice Address - Phone:301-230-2001
Practice Address - Fax:301-230-2002
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2014-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor