MEDICARE: DR. MARK A. STONE 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	DC16215	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC0162150	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1518062678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A. STONE D.C.

Provider Business Mailing Address
First Line	:	333 N LANTANA ST
Second Line	:	STE. 114
City	:	CAMARILLO
State	:	CA
Zip	:	93010-9010
Country	:	US
Telephone Number	:	805-987-1555
Fax Number	:	805-389-9695

Provider Business Practice Location Address
First Line	:	333 N LANTANA ST
Second Line	:	STE. 114
City	:	CAMARILLO
State	:	CA
Zip	:	93010-9010
Country	:	US
Telephone Number	:	805-987-1555
Fax Number	:	805-389-9695

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	09/20/2007

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Directions to “ DR. MARK A. STONE D.C.” Practice Location

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