Provider Demographics
NPI:1336418482
Name:FUERST, MARK D (DC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:FUERST
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 1:10963 VAN WERT DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-9211
Mailing Address - Country:US
Mailing Address - Phone:419-238-6686
Mailing Address - Fax:419-238-6201
Practice Address - Street 1:10963 VAN WERT DECATUR RD
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-9211
Practice Address - Country:US
Practice Address - Phone:419-238-6686
Practice Address - Fax:419-238-6201
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0064320Medicaid
OHH536770OtherGROUP PTAN
OH0064320Medicaid
OHH536770OtherGROUP PTAN