Healthcare Provider Details

I. General information

NPI: 1851325740
Provider Name (Legal Business Name): MARK OLIVER GOUR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 COFFEE RD
BAKERSFIELD CA
93308-5034
US

IV. Provider business mailing address

PO BOX 2479
PASO ROBLES CA
93447-2479
US

V. Phone/Fax

Practice location:
  • Phone: 661-587-9741
  • Fax:
Mailing address:
  • Phone: 661-587-9741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC24135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: