Provider Demographics
NPI:1538227467
Name:PLASTER, MARK D (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:PLASTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-1657
Mailing Address - Country:US
Mailing Address - Phone:308-254-7267
Mailing Address - Fax:
Practice Address - Street 1:1133 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-1657
Practice Address - Country:US
Practice Address - Phone:308-254-7267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081130400Medicaid
NE09551OtherBLUE CROSS
NE09551OtherBLUE CROSS
NE270294Medicare ID - Type Unspecified