MEDICARE: DR. MARK POTTER D.C.

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	921	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0781742	OTHER	MA	AETNA
2	Y39404	OTHER	MA	BCBS
3	4404373	OTHER	MA	UNITED HEALTHCARE
4	Y35709	OTHER	MA	BCBS
5	37821	OTHER	MA	CIGNA
6	275461	OTHER	MA	HEALTH SOURCE
7	715211	OTHER	MA	TUFTS

General Provider Information

NPI Number	:	1386795896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK POTTER D.C.

Provider Business Mailing Address
First Line	:	366 MASSACHUSETTS AVE
Second Line	:	SUITE 103
City	:	ARLINGTON
State	:	MA
Zip	:	02474-6733
Country	:	US
Telephone Number	:	781-648-8500
Fax Number	:	781-648-7171

Provider Business Practice Location Address
First Line	:	366 MASSACHUSETTS AVE
Second Line	:	SUITE 103
City	:	ARLINGTON
State	:	MA
Zip	:	02474-6733
Country	:	US
Telephone Number	:	781-648-8500
Fax Number	:	781-648-7171

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

Provider Enumeration Date	:	01/13/2007
Last Update Date	:	01/04/2008

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