Healthcare Provider Details

I. General information

NPI: 1366652679
Provider Name (Legal Business Name): DR MARK A KORCHOK DC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11867 MASON MONTGOMERY RD
CINCINNATI OH
45249-4712
US

IV. Provider business mailing address

11867 MASON MONTGOMERY RD
CINCINNATI OH
45249-4712
US

V. Phone/Fax

Practice location:
  • Phone: 513-677-2200
  • Fax: 513-677-2369
Mailing address:
  • Phone: 513-677-2200
  • Fax: 513-677-2369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberOH 1359
License Number StateOH

VIII. Authorized Official

Name: DR. MARK A KORCHOK
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: D.C.
Phone: 513-677-2200