Provider Demographics
NPI:1124093422
Name:KLINGERT, MARK JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:KLINGERT
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 1:16319 N 36 AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053
Mailing Address - Country:US
Mailing Address - Phone:602-978-0506
Mailing Address - Fax:
Practice Address - Street 1:16816 N 35 AVE
Practice Address - Street 2:STE 8
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2801
Practice Address - Country:US
Practice Address - Phone:602-843-3788
Practice Address - Fax:602-843-6485
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0085620OtherBCBS
T41832Medicare UPIN
Z76554Medicare ID - Type Unspecified