Provider Demographics
NPI:1659588937
Name:MARK W. FORD, JR., D.C., P.C.
Entity Type:Organization
Organization Name:MARK W. FORD, JR., D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:806-665-7261
Mailing Address - Street 1:701 N PRICE RD
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-5126
Mailing Address - Country:US
Mailing Address - Phone:806-665-7261
Mailing Address - Fax:806-665-0537
Practice Address - Street 1:701 N PRICE RD
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-5126
Practice Address - Country:US
Practice Address - Phone:806-665-7261
Practice Address - Fax:806-665-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603479OtherBLUE CROSS ID#
TXT92638Medicare UPIN
TX00Z492Medicare UPIN