Provider Demographics
NPI:1811028251
Name:EARNHART, MARK WHEELER (DC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:WHEELER
Last Name:EARNHART
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 1:545 SPRING ST.
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-1430
Mailing Address - Country:US
Mailing Address - Phone:360-378-5660
Mailing Address - Fax:360-378-9556
Practice Address - Street 1:545 SPRING STREET
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250
Practice Address - Country:US
Practice Address - Phone:360-378-5660
Practice Address - Fax:360-378-9556
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0018818OtherLABOR & INDUSTRIES
WA51005OtherREGENCE BLUE SHEILD