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General NPI Number Information
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NPI Number | 1487648093
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Entity Type | Individual
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Provider Name | MARK G OAS D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 1740 WESTGATE RD
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City | EAU CLAIRE
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State | WI
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Zip | 54703-4963
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Country | US
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Telephone | 715-552-7889
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Fax | 715-552-7939
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Provider Business Mailing Address
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Address Line | 1740 WESTGATE RD
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City | EAU CLAIRE
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State | WI
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Zip | 54703-4963
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Country | US
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Telephone | 715-552-7889
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Fax | 715-552-7939
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3823-012
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License Number State | WI
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