Provider Demographics
NPI:1134199136
Name:BITSKAY, MARK S (DC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:BITSKAY
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 1:103 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:OH
Mailing Address - Zip Code:44217-9425
Mailing Address - Country:US
Mailing Address - Phone:330-620-1159
Mailing Address - Fax:
Practice Address - Street 1:708 E SMITH RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2662
Practice Address - Country:US
Practice Address - Phone:330-725-5277
Practice Address - Fax:330-725-4241
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000139760OtherANTHEM
OH0826020Medicaid
OH1685OtherLICENSE
ND34178207500OtherWORKERS COMP #
ND0221638Medicaid
OH20813900OtherUS DEPT. OF LABOR-GROUP #
OH341820248-00OtherGROUP WORKER'S COMP #
OH20813900OtherUS DEPT. OF LABOR-GROUP #
OH1685OtherLICENSE
ND0221638Medicaid