Doctor Name: | MARK HENRY STREET |
NPI Number: | 1861487043 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | DC19619 |
Business Practice Address: | 1381 University St Healdsburg, CA - 954483314 |
Business Phone Number: | 7074318234 |
Business Fax Number: | 7074311427 |
Mailing Address: | 1381 University St, HEALDSBURG |
State: | CA |
Postal Code: | 954483314 |
Phone Number: | 7074335494 |
Fax Number: | |
NPI Enumeration Date: | 09/14/2005 |
NPI Last Update Date: | 10/27/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | DC19619 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |