Provider Demographics
NPI:1699204305
Name:SWITZER, MARK JOSEPH (LAC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:SWITZER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2709
Mailing Address - Country:US
Mailing Address - Phone:309-509-0109
Mailing Address - Fax:
Practice Address - Street 1:251 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-4716
Practice Address - Country:US
Practice Address - Phone:309-509-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001214171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist