Provider Demographics
NPI:1982929790
Name:BOONE, MARK S (LAC, CMTPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:BOONE
Suffix:
Gender:M
Credentials:LAC, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 24TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2637
Mailing Address - Country:US
Mailing Address - Phone:615-567-5928
Mailing Address - Fax:
Practice Address - Street 1:2 INTERNATIONAL PLZ
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-2017
Practice Address - Country:US
Practice Address - Phone:615-367-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist