Provider Demographics
NPI:1770180895
Name:O'BRIEN, MARK ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:O'BRIEN
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 1:1013 GENEVA CT
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4003
Mailing Address - Country:US
Mailing Address - Phone:570-690-5629
Mailing Address - Fax:
Practice Address - Street 1:350 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-3927
Practice Address - Country:US
Practice Address - Phone:570-690-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35782111NI0013X
CA34782111NX0100X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NX0100XChiropractic ProvidersChiropractorOccupational Health