Provider Demographics
NPI:1720422744
Name:MAEYAERT, MARK DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DOUGLAS
Last Name:MAEYAERT
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 1:2220 33RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7715
Mailing Address - Country:US
Mailing Address - Phone:712-336-4848
Mailing Address - Fax:712-336-4980
Practice Address - Street 1:2220 33RD ST STE A
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-7715
Practice Address - Country:US
Practice Address - Phone:712-336-4848
Practice Address - Fax:712-336-4980
Is Sole Proprietor?:No
Enumeration Date:2013-04-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor