Active NPI
Mark Mitchell Dederichs, DC LAC
- Acupuncturist
- Glendora, CA
National Provider Identifier
1114063708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 9187
- Practice address
- 1435 E RT 66
#C
Glendora, CA 91740-3748 - Phone
- (626) 963-6332
- Fax
- (626) 963-0262
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 16330 | CA | |
| Acupuncturist | 171100000X | 9187 | CA | Primary |
Addresses
Primary practice location
1435 E RT 66
#C
Glendora, CA 91740-3748
Mailing address
1435 E RT 66
#C
Glendora, CA 91740
Phone (626) 963-6332
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9187 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| 16330 | CA | MD | Adult Development & Aging Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1114063708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1435 E RT 66",
"address_2": "#C",
"city": "GLENDORA",
"state": "CA",
"postal_code": "91740",
"telephone_number": "626-963-6332",
"fax_number": "626-963-0262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1435 E RT 66",
"address_2": "#C",
"city": "GLENDORA",
"state": "CA",
"postal_code": "917403748",
"telephone_number": "626-963-6332",
"fax_number": "626-963-0262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDERICHS",
"first_name": "MARK",
"middle_name": "MITCHELL",
"name_prefix": "Mr.",
"credential": "DC LAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "16330",
"primary": false
},
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "9187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendora, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.