Provider Demographics
NPI:1700858503
Name:ALDEN, MARK EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:ALDEN
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 1:747 TARA FARMS DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-6846
Mailing Address - Country:US
Mailing Address - Phone:904-254-2834
Mailing Address - Fax:
Practice Address - Street 1:747 TARA FARMS DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-6846
Practice Address - Country:US
Practice Address - Phone:904-254-2834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 19689111N00000X
FLCH 10356111N00000X
GACHIR008824111N00000X
KY5405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor