Provider Demographics
NPI:1689940520
Name:MARK R LIMBERG D C LLC
Entity Type:Organization
Organization Name:MARK R LIMBERG D C LLC
Other - Org Name:BAVARIAN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:REBECCAH
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-652-3244
Mailing Address - Street 1:1022 WEISS ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1952
Mailing Address - Country:US
Mailing Address - Phone:989-652-3244
Mailing Address - Fax:989-652-6437
Practice Address - Street 1:1022 WEISS ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1952
Practice Address - Country:US
Practice Address - Phone:989-652-3244
Practice Address - Fax:989-652-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0G35020Medicare PIN