Mark Eric Vandever, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5566 Issued in AZ

Practice address

17224 N 43Rd Ave
Suite 105
Glendale, AZ 85308-4025

Phone

(602) 565-4402

Fax

(602) 843-3787

NPI assigned

Mar 22, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Renue Regenerative Medicine

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Peoria, AZ
  • NPI 1497349799
  NPD Authorized official

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730205550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17224 N 43RD AVE",
            "address_2": "SUITE 105",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853084025",
            "telephone_number": "602-565-4402",
            "fax_number": "602-843-3787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17224 N 43RD AVE",
            "address_2": "SUITE 105",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853084025",
            "telephone_number": "602-565-4402",
            "fax_number": "602-843-3787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEVER",
        "first_name": "MARK",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "5566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "5566",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly D Vana, FNP
• Mekhi Eleyon Vance
• Sadie Vance
• Hanna Vandendriessche, LAC
• Amy Elizabeth Vander Linden, PT
• H James Vandolah, MD
• Teaira Faithangel Vangaalen, PTA
• Jacob Vanleeuwen
• Leah Vanpoelvoorde, SLP
• Anayeli Varela

• Chiropractor in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.