Provider Demographics
NPI:1487738167
Name:PICK, MARK D (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:PICK
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 1:2300 N 14TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801
Mailing Address - Country:US
Mailing Address - Phone:620-225-3411
Mailing Address - Fax:620-225-0320
Practice Address - Street 1:2300 N 14TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801
Practice Address - Country:US
Practice Address - Phone:620-225-3411
Practice Address - Fax:620-225-0320
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03788111N00000X, 111NS0005X
MO006116111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060968Medicare ID - Type Unspecified
T43970Medicare UPIN