Provider Demographics
NPI:1912917196
Name:CHIUNGOS, MARK JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOHN
Last Name:CHIUNGOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:JOHN
Other - Last Name:CHIUNGOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:5 FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2884
Mailing Address - Country:US
Mailing Address - Phone:978-376-8190
Mailing Address - Fax:
Practice Address - Street 1:5 FLETCHER ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2708
Practice Address - Country:US
Practice Address - Phone:978-250-6886
Practice Address - Fax:978-250-6887
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3512134OtherHARVARD PILGRIM HEALTH
MA4400495OtherUNITED HEALTH CARE
MA1255068OtherCIGNA HEALTH CARE
MA3768980OtherAETNA
MA410314OtherTUFTS HEALTH CARE
MAY36499OtherBLUECROSSBLUESHIELD INDIV
MA3768980OtherAETNA
MAU66747Medicare UPIN