Provider Demographics
NPI:1720221997
Name:MONNIN, MARK L (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:MONNIN
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 1:580 HARBOR ST
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1904
Mailing Address - Country:US
Mailing Address - Phone:805-776-5100
Mailing Address - Fax:805-850-3305
Practice Address - Street 1:580 HARBOR ST
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1904
Practice Address - Country:US
Practice Address - Phone:805-776-5100
Practice Address - Fax:805-850-3305
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-18893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor