Doctor Name: | MR. MARK JOSEPH COLSTON |
NPI Number: | 1265585517 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | A.T.C., |
License Number: | 36000941A |
Business Practice Address: | 301 W Wabash Ave Crawfordsville, IN - 479332417 |
Business Phone Number: | 7653616159 |
Business Fax Number: | 7653616146 |
Mailing Address: | 363 W State Road 32, CRAWFORDSVILLE |
State: | IN |
Postal Code: | 479338965 |
Phone Number: | 7653616159 |
Fax Number: | 7653616146 |
NPI Enumeration Date: | 01/19/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 36000941A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |