Provider Demographics
NPI:1134201841
Name:ADDONA, MARK (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ADDONA
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 1:136 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2224
Mailing Address - Country:US
Mailing Address - Phone:908-276-6988
Mailing Address - Fax:
Practice Address - Street 1:767 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2528
Practice Address - Country:US
Practice Address - Phone:908-232-4448
Practice Address - Fax:908-232-4502
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC003253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ30378OtherMASTERCARE
NJ8950OtherOPERATING ENGINEERS LOCAL
NJ30026OtherUNITED HEALTHCARE
NJ1023951OtherCIGNA ASHN
NJ527731OtherAETNA
NJX8K51OtherWELLCHOICE
NJP589138OtherOXFORD
NJAD-45532Medicare ID - Type Unspecified
NJ1023951OtherCIGNA ASHN