Provider Demographics
NPI:1477644672
Name:HOOPER, MARK G (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:HOOPER
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 1:806 HINES ST W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3022
Mailing Address - Country:US
Mailing Address - Phone:252-237-2166
Mailing Address - Fax:252-237-2167
Practice Address - Street 1:806 HINES ST W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3022
Practice Address - Country:US
Practice Address - Phone:252-237-2166
Practice Address - Fax:252-237-2167
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08446OtherBCBSNC
NC8908446Medicaid
0186UOtherBCBS GROUP
NC890186UMedicaid
NCT64500Medicare UPIN
NC8908446Medicaid
NC890186UMedicaid