Provider Demographics
NPI:1255411377
Name:HAUSMANN, MARK THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:HAUSMANN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 MENDON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-1599
Mailing Address - Country:US
Mailing Address - Phone:508-966-2000
Mailing Address - Fax:508-966-2064
Practice Address - Street 1:90 MENDON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-1599
Practice Address - Country:US
Practice Address - Phone:508-966-2000
Practice Address - Fax:508-966-2064
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45679Medicare ID - Type UnspecifiedPROVIDER