Provider Demographics
NPI:1588754378
Name:TIERNEY, MARK STEPHEN (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:TIERNEY
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 1:103 HARTSHORN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2018
Mailing Address - Country:US
Mailing Address - Phone:781-942-4484
Mailing Address - Fax:
Practice Address - Street 1:301 MAIN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3616
Practice Address - Country:US
Practice Address - Phone:781-942-3660
Practice Address - Fax:781-942-1866
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1909111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1611461Medicaid
MA1611461Medicaid
MAY45015Medicare PIN