Provider Demographics
NPI:1881668267
Name:YEZAK, MARK CHRISTOPHER (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:YEZAK
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 1:25910 HAVEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-2673
Mailing Address - Country:US
Mailing Address - Phone:832-434-9300
Mailing Address - Fax:281-362-0233
Practice Address - Street 1:3101 COLLEGE PARK DR
Practice Address - Street 2:#100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4099
Practice Address - Country:US
Practice Address - Phone:281-362-0006
Practice Address - Fax:281-362-0233
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU62470Medicare UPIN
TXU62470Medicare UPIN