Provider Demographics
NPI:1972783942
Name:MERCER, MARK B (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:MERCER
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 1:3585 TELEGRAPH RD STE H
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3493
Mailing Address - Country:US
Mailing Address - Phone:805-650-9927
Mailing Address - Fax:805-212-8277
Practice Address - Street 1:3585 TELEGRAPH RD STE H
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3493
Practice Address - Country:US
Practice Address - Phone:805-650-9927
Practice Address - Fax:805-212-8277
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU79750Medicare UPIN