Provider Demographics
NPI:1215124235
Name:MARK FORD DC PLLC
Entity type:Organization
Organization Name:MARK FORD DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-673-7096
Mailing Address - Street 1:223 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-3176
Mailing Address - Country:US
Mailing Address - Phone:641-673-7096
Mailing Address - Fax:641-673-3848
Practice Address - Street 1:223 1ST AVE E
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-3176
Practice Address - Country:US
Practice Address - Phone:641-673-7096
Practice Address - Fax:641-673-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0424689Medicaid
IA0424689Medicaid
IAU20996Medicare UPIN