Healthcare Provider Details

I. General information

NPI: 1487738167
Provider Name (Legal Business Name): MARK D PICK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N 14TH AVE SUITE 200
DODGE CITY KS
67801
US

IV. Provider business mailing address

2300 N 14TH AVE SUITE 200
DODGE CITY KS
67801
US

V. Phone/Fax

Practice location:
  • Phone: 620-225-3411
  • Fax: 620-225-0320
Mailing address:
  • Phone: 620-225-3411
  • Fax: 620-225-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-03788
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006116
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number01-03788
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number006116
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: