Provider Demographics
NPI:1942312178
Name:MAUK, DAVID EUGENE (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EUGENE
Last Name:MAUK
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 1:1036 MT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302
Mailing Address - Country:US
Mailing Address - Phone:740-389-5151
Mailing Address - Fax:740-389-6994
Practice Address - Street 1:1036 MT VERNON AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-389-5151
Practice Address - Fax:740-389-6994
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000132604OtherANTHEM
OH350031086OtherRAILROAD MEDICARE
OH34148507100OtherBWC
OH4400014OtherUNITED HEALTHCARE
OH0480886Medicaid
OHMA0499901Medicare ID - Type Unspecified
OH0480886Medicaid