Healthcare Provider Details

I. General information

NPI: 1770180895
Provider Name (Legal Business Name): MARK ALLEN O'BRIEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 GREEN VALLEY RD
EL DORADO HILLS CA
95762-3927
US

IV. Provider business mailing address

1013 GENEVA CT
EL DORADO HILLS CA
95762-4003
US

V. Phone/Fax

Practice location:
  • Phone: 570-690-5629
  • Fax:
Mailing address:
  • Phone: 570-690-5629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number35782
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number34782
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: