MEDICARE: DR. MARK A PRADO 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	2313	OK

General Provider Information

NPI Number	:	1508053331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A PRADO DC

Provider Business Mailing Address
First Line	:	504 N 1ST ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-4145
Country	:	US
Telephone Number	:	580-718-0800
Fax Number	:	580-718-0803

Provider Business Practice Location Address
First Line	:	504 N 1ST ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-4145
Country	:	US
Telephone Number	:	580-718-0800
Fax Number	:	580-718-0803

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

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/25/2007

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