Provider Demographics
NPI:1841282514
Name:MCCANN, MARK A (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:MCCANN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 CLARMAR DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2675
Mailing Address - Country:US
Mailing Address - Phone:608-318-5929
Mailing Address - Fax:608-318-5922
Practice Address - Street 1:978 PARK ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-3653
Practice Address - Country:US
Practice Address - Phone:608-835-8635
Practice Address - Fax:608-835-3772
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38801100Medicaid
WIT62712Medicare UPIN
WI38801100Medicaid