Provider Demographics
NPI:1780143487
Name:DEARDORFF, MARK STEVEN (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:DEARDORFF
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 1:501 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1594
Mailing Address - Country:US
Mailing Address - Phone:717-763-7711
Mailing Address - Fax:717-763-7197
Practice Address - Street 1:501 MARKET ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1594
Practice Address - Country:US
Practice Address - Phone:717-763-7711
Practice Address - Fax:717-763-7197
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor