Provider Demographics
NPI:1801939046
Name:EMERSON, MARK DEREK (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DEREK
Last Name:EMERSON
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 1:14375 SARATOGA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5988
Mailing Address - Country:US
Mailing Address - Phone:408-872-1031
Mailing Address - Fax:408-872-1074
Practice Address - Street 1:14375 SARATOGA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5988
Practice Address - Country:US
Practice Address - Phone:408-872-1031
Practice Address - Fax:408-872-1074
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI851111N00000X
CA26278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI851OtherHAWAII CHIROPRACTIC LICEN
CA26278OtherCA-LICENSE