Provider Demographics
NPI:1629061858
Name:BALDERSTON, MARK STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:BALDERSTON
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 1:17202 MIDLAND DR.
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-8901
Mailing Address - Country:US
Mailing Address - Phone:913-631-8888
Mailing Address - Fax:913-268-8390
Practice Address - Street 1:17202 MIDLAND DR.
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-8901
Practice Address - Country:US
Practice Address - Phone:913-631-8888
Practice Address - Fax:913-268-8390
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03482111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSM944098Medicare PIN
KST42316Medicare UPIN