Healthcare Provider Details

I. General information

NPI: 1447370705
Provider Name (Legal Business Name): MARK R DULBERG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 CIVIC CENTER ST
RICHMOND CA
94804-1817
US

IV. Provider business mailing address

244 CIVIC CENTER ST
RICHMOND CA
94804-1817
US

V. Phone/Fax

Practice location:
  • Phone: 510-236-7800
  • Fax: 510-236-7803
Mailing address:
  • Phone: 510-236-7800
  • Fax: 510-236-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC0171070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: