Healthcare Provider Details

I. General information

NPI: 1407635196
Provider Name (Legal Business Name): MARK WADE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 53RD ST N STE 6
PINELLAS PARK FL
33781-5629
US

IV. Provider business mailing address

225 1ST AVE N UNIT 2201
ST PETERSBURG FL
33701-3739
US

V. Phone/Fax

Practice location:
  • Phone: 727-233-5268
  • Fax:
Mailing address:
  • Phone: 727-685-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH14706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: