Provider Demographics
NPI:1124133368
Name:JOSEPH, MARK ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:JOSEPH
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 1:1785 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-8915
Mailing Address - Country:US
Mailing Address - Phone:734-242-1200
Mailing Address - Fax:734-242-1191
Practice Address - Street 1:7585 NORTH TELEGRAPH ROAD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-8915
Practice Address - Country:US
Practice Address - Phone:734-242-1200
Practice Address - Fax:734-242-1191
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMJ005541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E850250OtherBCBS
MI950E850250OtherBCBS