Provider Demographics
NPI:1841282431
Name:DUELL, MARK L SR (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:DUELL
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 1:5350 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2326
Mailing Address - Country:US
Mailing Address - Phone:805-967-3409
Mailing Address - Fax:805-967-3401
Practice Address - Street 1:5350 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2326
Practice Address - Country:US
Practice Address - Phone:805-967-3409
Practice Address - Fax:805-967-3401
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
CA16347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18695Medicare ID - Type Unspecified