Provider Demographics
NPI:1336218783
Name:MARK B MERCER CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:MARK B MERCER CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-650-9927
Mailing Address - Street 1:3585 TELEGRAPH RD STE H
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3493
Mailing Address - Country:US
Mailing Address - Phone:805-650-9927
Mailing Address - Fax:805-644-3430
Practice Address - Street 1:3585 TELEGRAPH RD STE H
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3493
Practice Address - Country:US
Practice Address - Phone:805-650-9927
Practice Address - Fax:805-644-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26447OtherSTATE LICENSE
CADC0264470OtherBLUE SHIELD
CADC26447OtherBLUE CROSS
CAU79750Medicare PIN
CADC0264470OtherBLUE SHIELD