Michael David Mark, LA.C, DIPL. O.M.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

17044 Issued in CA

Practice address

13677 Foothill Blvd Ste P
Fontana, CA 92335-0214

Phone

(909) 766-5397

Fax

(909) 697-2274

NPI assigned

Aug 11, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fontana Chiropractic and Acupuncture

  • Chiropractor
  • Fontana, CA
  • NPI 1700334166

  Acupuncturist

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470873600000",
    "number": "1508310244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20687 AMAR ROAD STE 2 BOX 240",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "91789",
            "telephone_number": "909-766-5397",
            "fax_number": "909-697-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13677 FOOTHILL BLVD STE P",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923350214",
            "telephone_number": "909-766-5397",
            "fax_number": "909-697-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARK",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "credential": "LA.C, DIPL. O.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-11",
        "last_updated": "2016-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "17044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in Fontana, CA
• Providers in Fontana, CA by specialty
• Acupuncturist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.