Healthcare Provider Details

I. General information

NPI: 1528072725
Provider Name (Legal Business Name): MARK ALLEN HAMPTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E 3RD ST
WILLIAMSPORT PA
17701-5411
US

IV. Provider business mailing address

1111 E 3RD ST
WILLIAMSPORT PA
17701-5411
US

V. Phone/Fax

Practice location:
  • Phone: 570-322-5500
  • Fax:
Mailing address:
  • Phone: 570-322-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-004453L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: