Healthcare Provider Details

I. General information

NPI: 1669543179
Provider Name (Legal Business Name): MARK W STRAUSS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 D. ST. #D
SAN RAFAEL CA
94901-3705
US

IV. Provider business mailing address

712 D. ST. SUITE D
SAN RAFAEL CA
94901-3705
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-6999
  • Fax:
Mailing address:
  • Phone: 415-457-6999
  • Fax: 415-457-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberD.C.0199990
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC19999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: