Provider Demographics
NPI:1609198852
Name:AHRENS, MARK ALLAN (DC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLAN
Last Name:AHRENS
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 1:2913 CORPORATE CIR
Mailing Address - Street 2:STE 400
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-5616
Mailing Address - Country:US
Mailing Address - Phone:214-470-6774
Mailing Address - Fax:972-692-7280
Practice Address - Street 1:3305 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2702
Practice Address - Country:US
Practice Address - Phone:214-470-6774
Practice Address - Fax:972-724-2049
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB164271OtherMEDICARE PTAN
608755OtherBLUE CROSS BLUE SHEILD RECORD ID