Provider Demographics
NPI:1245325703
Name:LIEFFRING, MARK J (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:LIEFFRING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1219 14TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-3703
Mailing Address - Country:US
Mailing Address - Phone:218-878-0895
Mailing Address - Fax:218-485-8941
Practice Address - Street 1:1219 14TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-3703
Practice Address - Country:US
Practice Address - Phone:218-878-0895
Practice Address - Fax:218-485-8941
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN055527400Medicaid
MN61950LIOtherBCBS ID
MN230492OtherACN ID
MN230492OtherACN ID