MEDICARE: MARK LUDEAN UNGERANK 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	904	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518974914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK LUDEAN UNGERANK DC

Provider Business Mailing Address
First Line	:	1 MEDICAL PLZ
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-2918
Country	:	US
Telephone Number	:	870-425-2515
Fax Number	:	870-425-2710

Provider Business Practice Location Address
First Line	:	1 MEDICAL PLZ
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-2918
Country	:	US
Telephone Number	:	870-425-2515
Fax Number	:	870-425-2710

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/14/2019

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Directions to “ MARK LUDEAN UNGERANK DC” Practice Location

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