Provider Demographics
NPI:1801835574
Name:ESCOBEDO, MARK U (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:U
Last Name:ESCOBEDO
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:121 SPARKLEBERRY CROSSING RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8639
Mailing Address - Country:US
Mailing Address - Phone:803-788-2167
Mailing Address - Fax:803-788-4165
Practice Address - Street 1:121 SPARKLEBERRY CROSSING RD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8639
Practice Address - Country:US
Practice Address - Phone:803-788-2167
Practice Address - Fax:803-788-4165
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC2360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2360Medicaid
SC0281Medicare PIN
SCCH2360Medicaid
SCU75330Medicare UPIN