Provider Demographics
NPI:1811055023
Name:SEWELL, MARK ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:SEWELL
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 1:3291 S THOMPSON ST
Mailing Address - Street 2:STE D102
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7357
Mailing Address - Country:US
Mailing Address - Phone:479-756-9661
Mailing Address - Fax:479-756-6251
Practice Address - Street 1:4618 S THOMPSON ST STE D
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7467
Practice Address - Country:US
Practice Address - Phone:479-756-9661
Practice Address - Fax:479-756-6251
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U311Medicare ID - Type Unspecified
ARU74593Medicare UPIN