Provider Demographics
NPI:1720312812
Name:STEENERSON, MARK JEFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JEFFREY
Last Name:STEENERSON
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 1:21025 COMMERCE BLVD
Mailing Address - Street 2:SUITE 800 P.O. BOX 3
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4695
Mailing Address - Country:US
Mailing Address - Phone:763-300-3456
Mailing Address - Fax:763-428-1609
Practice Address - Street 1:21025 COMMERCE BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4695
Practice Address - Country:US
Practice Address - Phone:763-300-3456
Practice Address - Fax:763-428-1609
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor