Provider Demographics
NPI:1699797084
Name:OAKES, MARK W (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:OAKES
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 1:797 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2563
Mailing Address - Country:US
Mailing Address - Phone:814-724-3239
Mailing Address - Fax:814-724-1110
Practice Address - Street 1:797 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2563
Practice Address - Country:US
Practice Address - Phone:814-724-3239
Practice Address - Fax:814-724-1110
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007950L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOA602762OtherHIGHMARK BC/BS
PAOA1450542OtherPERSONAL CHOICE
PA2133933000OtherKEYSTONE HEALTHPLAN EAST
PA2133933000OtherKEYSTONE HEALTHPLAN EAST