Provider Demographics
NPI:1811191125
Name:TEJAN, MARK STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:TEJAN
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 1:4012 JORDAN STREET BOX 420
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15081-0420
Mailing Address - Country:US
Mailing Address - Phone:724-375-5534
Mailing Address - Fax:724-375-5575
Practice Address - Street 1:4012 JORDAN STREET
Practice Address - Street 2:
Practice Address - City:SOUTH HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15081
Practice Address - Country:US
Practice Address - Phone:724-375-5534
Practice Address - Fax:724-375-5575
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003643L111N00000X
PAAJ003643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000514603OtherHIGHMARK BC BS
PA1198057OtherCIGNA
PA141190Medicaid
PA0004258151OtherAETNA PPO
PA1984961-01Medicaid
PA0011157650001Medicaid
PA381900OtherUNITED HEALTHCARE
PA200146OtherUPMC
PA329860OtherHEALTH AMERICA
PA2675833OtherAETNA HMO
PAMT382067OtherASHN
PA000514603OtherHIGHMARK BC BS
PA381900OtherUNITED HEALTHCARE