Dr. Glen Robert Mark, D.C.
Chiropractor in Riverhead, NY. Individual provider (NPI-1).
NPI number1669415238
StatusActive
Last updated in NPPESMar 10, 2020
Details
- NPI
- 1669415238
- Entity type
- Individual (NPI-1)
- Name
- Dr. Glen Robert Mark
- Credential
- D.C.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 13, 2006
- Certification date
- Mar 10, 2020
- Last updated
- Mar 10, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111N00000X | Chiropractor | XOO7337-1 | NY | Yes |
Practice location
633 Roanoke AveRiverhead, NY 11901-2727
Phone 631-727-3795 · Fax 631-727-1961
Mailing address
633 Roanoke AveRiverhead, NY 11901-2789
Phone 631-727-3795 · Fax 631-727-1961
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All 16 Chiropractor providers in Riverhead · All 1,248 providers in Riverhead
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