Healthcare Provider Details

I. General information

NPI: 1508169269
Provider Name (Legal Business Name): MICHAEL THOMAS MARKS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BRISTOL ST SUITE C-105
COSTA MESA CA
92626-5981
US

IV. Provider business mailing address

2900 BRISTOL ST SUITE C-105
COSTA MESA CA
92626-5981
US

V. Phone/Fax

Practice location:
  • Phone: 714-557-9454
  • Fax: 714-557-9534
Mailing address:
  • Phone: 714-557-9454
  • Fax: 714-557-9534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC31689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: