Provider Demographics
NPI:1023096542
Name:DEAN, MARK STEVEN (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:DEAN
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 1:2125 E MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-5571
Mailing Address - Country:US
Mailing Address - Phone:479-373-1030
Mailing Address - Fax:479-373-1033
Practice Address - Street 1:2125 E MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-5571
Practice Address - Country:US
Practice Address - Phone:479-373-1030
Practice Address - Fax:479-373-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158215718Medicaid
U08973Medicare UPIN
AR158215718Medicaid