Provider Demographics
NPI:1992854996
Name:MARK, STEVEN WADE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WADE
Last Name:MARK
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 1:2 HARNESS LN
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2310
Mailing Address - Country:US
Mailing Address - Phone:732-607-1133
Mailing Address - Fax:732-607-1145
Practice Address - Street 1:2 HARNESS LN
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2310
Practice Address - Country:US
Practice Address - Phone:732-607-1133
Practice Address - Fax:732-607-1145
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00386100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor