Provider Demographics
NPI:1811956592
Name:GUICE, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GUICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7645 PINES RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-3905
Mailing Address - Country:US
Mailing Address - Phone:318-683-0300
Mailing Address - Fax:318-687-3937
Practice Address - Street 1:7645 PINES RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3905
Practice Address - Country:US
Practice Address - Phone:318-683-0300
Practice Address - Fax:318-687-3937
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1953423Medicaid
ARU59000Medicare UPIN
AR1953423Medicaid