Provider Demographics
NPI:1659479509
Name:LIQUE, MARK KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:KEVIN
Last Name:LIQUE
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 1:606 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-1206
Mailing Address - Country:US
Mailing Address - Phone:978-521-2225
Mailing Address - Fax:978-521-2678
Practice Address - Street 1:606 BROADWAY
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-1206
Practice Address - Country:US
Practice Address - Phone:978-521-2225
Practice Address - Fax:978-521-2678
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH747-0905111N00000X
MA2921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2952014OtherCIGNA
NH05Y009056NH01OtherANTHEM BCBS
NHAA53239OtherHARVARD PILGRIM
NHAA53239OtherHARVARD PILGRIM