Provider Demographics
NPI:1356527170
Name:DR MARK SHERROD PA
Entity type:Organization
Organization Name:DR MARK SHERROD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:COLIN
Authorized Official - Last Name:SHERROD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-353-5239
Mailing Address - Street 1:5406 WINNERS CIR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-4634
Mailing Address - Country:US
Mailing Address - Phone:806-353-5239
Mailing Address - Fax:
Practice Address - Street 1:5406 WINNERS CIR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79110-4634
Practice Address - Country:US
Practice Address - Phone:806-353-5239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00901UMedicare PIN
TXT15879Medicare UPIN