Provider Demographics
NPI:1245700293
Name:SICHENEDER, MARK (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SICHENEDER
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 1:3650 CARPENTER RD STE C
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8591
Mailing Address - Country:US
Mailing Address - Phone:734-489-1714
Mailing Address - Fax:734-544-5441
Practice Address - Street 1:3650 CARPENTER RD STE C
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8591
Practice Address - Country:US
Practice Address - Phone:734-489-1714
Practice Address - Fax:734-544-5441
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor