Provider Demographics
NPI:1184801078
Name:MARK
Entity type:Organization
Organization Name:MARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUTTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC LLC
Authorized Official - Phone:970-207-4066
Mailing Address - Street 1:4745 BOARDWALK DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3768
Mailing Address - Country:US
Mailing Address - Phone:970-207-4066
Mailing Address - Fax:970-225-1392
Practice Address - Street 1:4745 BOARDWALK DR
Practice Address - Street 2:UNIT C1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3768
Practice Address - Country:US
Practice Address - Phone:970-207-4066
Practice Address - Fax:970-225-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC528928Medicare PIN