Provider Demographics
NPI:1063560407
Name:HARDWICK, MARK TY (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:TY
Last Name:HARDWICK
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 1:27151 479TH AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57032-8220
Mailing Address - Country:US
Mailing Address - Phone:605-351-3645
Mailing Address - Fax:605-332-6616
Practice Address - Street 1:4925 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-6950
Practice Address - Country:US
Practice Address - Phone:605-334-7371
Practice Address - Fax:605-332-6616
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor