Provider Demographics
NPI:1811031891
Name:OCHADLEUS, MARK HUGH
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HUGH
Last Name:OCHADLEUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2427
Mailing Address - Country:US
Mailing Address - Phone:810-664-5310
Mailing Address - Fax:
Practice Address - Street 1:498 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2427
Practice Address - Country:US
Practice Address - Phone:810-664-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICH 440004OtherM CARE
MI10369OtherGREAT LAKES
MI0980076OtherHEALTH PLUS
MICH 440004OtherM CARE
MIU61362Medicare UPIN