Healthcare Provider Details

I. General information

NPI: 1730351321
Provider Name (Legal Business Name): MARK D. WOLOSHIN, D.C.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S 8TH ST
NOBLESVILLE IN
46060-2714
US

IV. Provider business mailing address

PO BOX 1723
NOBLESVILLE IN
46061-1723
US

V. Phone/Fax

Practice location:
  • Phone: 317-773-3488
  • Fax: 317-773-2680
Mailing address:
  • Phone: 317-773-3488
  • Fax: 317-773-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number51000212A
License Number StateIN

VIII. Authorized Official

Name: DR. MARK WOLOSHIN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 317-773-3488