Provider Demographics
NPI:1104978667
Name:MAIER, MARK STEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:MAIER
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 1:1944 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5510
Mailing Address - Country:US
Mailing Address - Phone:772-878-6500
Mailing Address - Fax:772-878-6501
Practice Address - Street 1:1944 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5510
Practice Address - Country:US
Practice Address - Phone:772-878-6500
Practice Address - Fax:772-878-6501
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU16450Medicare UPIN
FL53937Medicare ID - Type UnspecifiedMEDICARE NUMBER