Provider Demographics
NPI:1710034772
Name:SANEMAN, MARK S (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:SANEMAN
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 1:637 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4445
Mailing Address - Country:US
Mailing Address - Phone:817-966-8772
Mailing Address - Fax:
Practice Address - Street 1:170 SYCAMORE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-5008
Practice Address - Country:US
Practice Address - Phone:817-615-8200
Practice Address - Fax:817-615-8203
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00349YMedicare ID - Type UnspecifiedPROVIDER NUMBER