Provider Demographics
NPI:1588755037
Name:DULBERG, MARK L (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:DULBERG
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 1:3431 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4426
Mailing Address - Country:US
Mailing Address - Phone:305-945-4080
Mailing Address - Fax:305-945-0806
Practice Address - Street 1:3431 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4426
Practice Address - Country:US
Practice Address - Phone:305-945-4080
Practice Address - Fax:305-945-0806
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55818OtherBLUE CROSS BLUE SHIELD
FLFL65090OtherLANDMARK
FLFL65090OtherLANDMARK