Provider Demographics
NPI:1457693798
Name:CLEANER, MARK JAY (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:CLEANER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:11879 KEMPER RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9021
Mailing Address - Country:US
Mailing Address - Phone:530-885-3154
Mailing Address - Fax:530-885-3192
Practice Address - Street 1:11879 KEMPER RD
Practice Address - Street 2:SUITE 3
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-9021
Practice Address - Country:US
Practice Address - Phone:530-885-3154
Practice Address - Fax:530-885-3192
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA15890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor