Provider Demographics
NPI:1427090299
Name:TOBIAS, MARK JOSEPH (DC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:JOSEPH
Last Name:TOBIAS
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 1:6276 JACKSON RD
Mailing Address - Street 2:#D
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103
Mailing Address - Country:US
Mailing Address - Phone:734-995-8770
Mailing Address - Fax:734-995-7201
Practice Address - Street 1:6276 JACKSON RD
Practice Address - Street 2:#D
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103
Practice Address - Country:US
Practice Address - Phone:734-995-8770
Practice Address - Fax:734-995-7201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMT005217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U38444Medicare UPIN
MIH17636001Medicare ID - Type Unspecified