Provider Demographics
NPI:1710949110
Name:KIRK, MARK JAMES (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:KIRK
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 1:116 W LIMA ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-3032
Mailing Address - Country:US
Mailing Address - Phone:419-425-9798
Mailing Address - Fax:419-425-9698
Practice Address - Street 1:116 W LIMA ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3032
Practice Address - Country:US
Practice Address - Phone:419-425-9798
Practice Address - Fax:419-425-9698
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2014957Medicaid
OHKI0817742Medicare ID - Type Unspecified
OH2014957Medicaid