Provider Demographics
NPI:1851550511
Name:SCHILLERSTROM, MARK D (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:SCHILLERSTROM
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 1:5750 W THUNDERBIRD RD
Mailing Address - Street 2:STE. D460
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4660
Mailing Address - Country:US
Mailing Address - Phone:602-298-1902
Mailing Address - Fax:602-298-1903
Practice Address - Street 1:5750 W THUNDERBIRD RD
Practice Address - Street 2:STE. D460
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4660
Practice Address - Country:US
Practice Address - Phone:602-298-1902
Practice Address - Fax:602-298-1903
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor