Provider Demographics
NPI:1295935039
Name:ROBINSON, MARK A (DC,)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:ROBINSON
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:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-0264
Mailing Address - Country:US
Mailing Address - Phone:417-358-7831
Mailing Address - Fax:417-358-9831
Practice Address - Street 1:1214 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-1031
Practice Address - Country:US
Practice Address - Phone:417-358-7831
Practice Address - Fax:417-358-9831
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32408Medicare PIN