Healthcare Provider Details

I. General information

NPI: 1700858503
Provider Name (Legal Business Name): MARK EDWARD ALDEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 TARA FARMS DR
MIDDLEBURG FL
32068-6846
US

IV. Provider business mailing address

747 TARA FARMS DR
MIDDLEBURG FL
32068-6846
US

V. Phone/Fax

Practice location:
  • Phone: 904-254-2834
  • Fax:
Mailing address:
  • Phone: 904-254-2834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 19689
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 10356
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008824
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5405
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: