MEDICARE: MARK EDGAR SICHLEY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2777	OH

General Provider Information

NPI Number	:	1043295116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK EDGAR SICHLEY DC

Provider Business Mailing Address
First Line	:	8137 COLUMBIA RD
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-2023
Country	:	US
Telephone Number	:	440-427-1602
Fax Number	:	440-427-1598

Provider Business Practice Location Address
First Line	:	8137 COLUMBIA RD
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-2023
Country	:	US
Telephone Number	:	440-427-1602
Fax Number	:	440-427-1598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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