Provider Demographics
NPI:1003887548
Name:HEMBREE, MARK RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:HEMBREE
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 1:2004 W GRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0537
Mailing Address - Country:US
Mailing Address - Phone:903-561-0086
Mailing Address - Fax:903-561-2576
Practice Address - Street 1:2004 W GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0537
Practice Address - Country:US
Practice Address - Phone:903-561-0086
Practice Address - Fax:903-561-2576
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001161102Medicaid
TX8R6370OtherBCBS OF TEXAS
TX8D1928Medicare PIN
TX8R6370OtherBCBS OF TEXAS