Provider Demographics
NPI:1760551360
Name:KORCHOK, MARK ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:KORCHOK
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 1:11867 MASON MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-4712
Mailing Address - Country:US
Mailing Address - Phone:513-677-2200
Mailing Address - Fax:513-677-2369
Practice Address - Street 1:11867 MASON MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-4712
Practice Address - Country:US
Practice Address - Phone:513-677-2200
Practice Address - Fax:513-677-2369
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-1359111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0797553Medicaid
OH0797553Medicaid
OH4230221Medicare PIN