MEDICARE: DR. MARK ALLAN HAVERTAPE 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	A05832	IA

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	:	1881613495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALLAN HAVERTAPE D.C.

Provider Business Mailing Address
First Line	:	3804 1ST AVE NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-5603
Country	:	US
Telephone Number	:	319-364-6387
Fax Number	:

Provider Business Practice Location Address
First Line	:	3804 1ST AVE NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-5603
Country	:	US
Telephone Number	:	319-364-6387
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/09/2007

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