MEDICARE: MARK ANDREW GVIST DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	A05327	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245206101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ANDREW GVIST DC

Provider Business Mailing Address
First Line	:	204 S 1ST ST
Second Line	:	BOX 133
City	:	CARLISLE
State	:	IA
Zip	:	50047-7601
Country	:	US
Telephone Number	:	515-989-0097
Fax Number	:	515-989-9009

Provider Business Practice Location Address
First Line	:	204 S 1ST ST
Second Line	:
City	:	CARLISLE
State	:	IA
Zip	:	50047-7601
Country	:	US
Telephone Number	:	515-989-0097
Fax Number	:	515-989-9009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	10/04/2011

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Directions to “ MARK ANDREW GVIST DC” Practice Location

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