Provider Demographics
NPI:1669679866
Name:MULAK, MARK J (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:MULAK
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 1:900 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4453
Mailing Address - Country:US
Mailing Address - Phone:401-272-5710
Mailing Address - Fax:401-272-5711
Practice Address - Street 1:900 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4453
Practice Address - Country:US
Practice Address - Phone:401-272-5710
Practice Address - Fax:401-272-5711
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor