Provider Demographics
NPI:1386795896
Name:POTTER, MARK (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:POTTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:366 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6733
Mailing Address - Country:US
Mailing Address - Phone:781-648-8500
Mailing Address - Fax:781-648-7171
Practice Address - Street 1:366 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6733
Practice Address - Country:US
Practice Address - Phone:781-648-8500
Practice Address - Fax:781-648-7171
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0781742OtherAETNA
MAY39404OtherBCBS
MA4404373OtherUNITED HEALTHCARE
MAY35709OtherBCBS
MA37821OtherCIGNA
MA275461OtherHEALTH SOURCE
MA715211OtherTUFTS
MAY39404OtherBCBS