Provider Demographics
NPI:1902817760
Name:MEANS, MARK CLINTON (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CLINTON
Last Name:MEANS
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 1:2101 CLUB HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-2521
Mailing Address - Country:US
Mailing Address - Phone:239-543-3006
Mailing Address - Fax:
Practice Address - Street 1:150 PONDELLA RD
Practice Address - Street 2:
Practice Address - City:N FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3846
Practice Address - Country:US
Practice Address - Phone:239-997-5007
Practice Address - Fax:239-997-2285
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT96763Medicare UPIN
FL88967Medicare ID - Type Unspecified