Provider Demographics
NPI:1063036531
Name:MARK D KIRSHNER FOOT BALANCE
Entity type:Organization
Organization Name:MARK D KIRSHNER FOOT BALANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-247-4809
Mailing Address - Street 1:2620 MINERAL SPRINGS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-1570
Mailing Address - Country:US
Mailing Address - Phone:865-247-4809
Mailing Address - Fax:865-247-4927
Practice Address - Street 1:2620 MINERAL SPRINGS AVE STE A
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1570
Practice Address - Country:US
Practice Address - Phone:865-247-4809
Practice Address - Fax:865-247-4927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Multi-Specialty