Provider Demographics
NPI:1700931805
Name:MEHAFFEY, MARK D (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:MEHAFFEY
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 1:1030 N GRANDVIEW
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761
Mailing Address - Country:US
Mailing Address - Phone:432-332-3388
Mailing Address - Fax:432-332-3390
Practice Address - Street 1:1020 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-332-3388
Practice Address - Fax:432-332-3390
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U20719Medicare UPIN