Provider Demographics
NPI:1932238698
Name:CLUKEY, MARK ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:CLUKEY
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 1:220 WOODWARD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1757
Mailing Address - Country:US
Mailing Address - Phone:570-893-1952
Mailing Address - Fax:570-893-1952
Practice Address - Street 1:220 WOODWARD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1757
Practice Address - Country:US
Practice Address - Phone:570-893-1952
Practice Address - Fax:570-893-1952
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACL-003668-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACL-1643451OtherHIGHMARK BLUE SHIELD
PACL-1643451OtherHIGHMARK BLUE SHIELD