Provider Demographics
NPI:1033751581
Name:PAVELEK, MARK THOMAS JR (DC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:THOMAS
Last Name:PAVELEK
Suffix:JR
Gender:M
Credentials:DC
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Mailing Address - Street 1:5495 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072
Mailing Address - Country:US
Mailing Address - Phone:803-708-4258
Mailing Address - Fax:803-708-4373
Practice Address - Street 1:5495 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-490-0946
Practice Address - Fax:803-708-4373
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC4491111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner