Provider Demographics
NPI:1801881008
Name:SCHOPP, MARK EDWARD SR (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:SCHOPP
Suffix:SR
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 1:11422 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3698
Mailing Address - Country:US
Mailing Address - Phone:314-843-9355
Mailing Address - Fax:866-849-5845
Practice Address - Street 1:11422 GRAVOIS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3698
Practice Address - Country:US
Practice Address - Phone:314-843-9355
Practice Address - Fax:866-849-5845
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT43529Medicare UPIN