Provider Demographics
NPI:1881856318
Name:SPRINGER, MARK (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SPRINGER
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 1:4221 N HIMES AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6229
Mailing Address - Country:US
Mailing Address - Phone:813-874-7217
Mailing Address - Fax:813-769-0884
Practice Address - Street 1:2441 US HIGHWAY 98 W
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-5385
Practice Address - Country:US
Practice Address - Phone:850-622-0062
Practice Address - Fax:850-622-0007
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89528OtherBLUE CROSS BLUE SHIELD