Provider Demographics
NPI:1629122668
Name:WEBB, MARK L (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:WEBB
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 1:3850 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3701
Mailing Address - Country:US
Mailing Address - Phone:253-845-9098
Mailing Address - Fax:253-904-1038
Practice Address - Street 1:3850 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3701
Practice Address - Country:US
Practice Address - Phone:253-845-9098
Practice Address - Fax:253-904-1038
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1770OtherL & I
WA1770OtherL & I
T02818Medicare UPIN