Provider Demographics
NPI:1841494010
Name:TRELL, MARK PATRICK (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:PATRICK
Last Name:TRELL
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 1:205 W MILLBROOK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4492
Mailing Address - Country:US
Mailing Address - Phone:919-755-0024
Mailing Address - Fax:919-782-3064
Practice Address - Street 1:205 W MILLBROOK RD STE 205
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4492
Practice Address - Country:US
Practice Address - Phone:919-755-0024
Practice Address - Fax:919-782-3064
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0882GOtherBLUE CROSS BLUE SHIELD
NC2456621Medicare ID - Type Unspecified