Provider Demographics
NPI:1023027844
Name:WARTA, MARK JON (DC FASA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JON
Last Name:WARTA
Suffix:
Gender:M
Credentials:DC FASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67730-1826
Mailing Address - Country:US
Mailing Address - Phone:785-626-3274
Mailing Address - Fax:785-626-3725
Practice Address - Street 1:418 MAIN ST
Practice Address - Street 2:
Practice Address - City:ATWOOD
Practice Address - State:KS
Practice Address - Zip Code:67730-1826
Practice Address - Country:US
Practice Address - Phone:785-626-3274
Practice Address - Fax:785-626-3725
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660081Medicare ID - Type Unspecified