Provider Demographics
NPI:1982630869
Name:GUTEKUNST, MARK R (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:GUTEKUNST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1245 CEDAR RD
Mailing Address - Street 2:C
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7141
Mailing Address - Country:US
Mailing Address - Phone:757-549-1664
Mailing Address - Fax:757-549-2445
Practice Address - Street 1:1245 CEDAR RD
Practice Address - Street 2:C
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7141
Practice Address - Country:US
Practice Address - Phone:757-549-1664
Practice Address - Fax:757-549-2445
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790973OtherCIGNA
44-00363OtherUNITED HEALTH CARE
4657152OtherAETNA
VA042725OtherANTHEM BLUE CROSS
10384080OtherCAQH
44-00363OtherUNITED HEALTH CARE