Provider Demographics
NPI:1871676023
Name:SCANLON, MARK J (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:SCANLON
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 1:9494 CINCINNATI COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1161
Mailing Address - Country:US
Mailing Address - Phone:513-755-8020
Mailing Address - Fax:513-755-8021
Practice Address - Street 1:9494 CINCINNATI COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-1161
Practice Address - Country:US
Practice Address - Phone:513-755-8020
Practice Address - Fax:513-755-8021
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000020360OtherANTHEM PROVIDER NUMBER
OH0994072Medicaid
OH000000020360OtherANTHEM PROVIDER NUMBER