Provider Demographics
NPI:1548269681
Name:MYLAN, MARK ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:MYLAN
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 1:850 22ND AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1688
Mailing Address - Country:US
Mailing Address - Phone:319-358-8999
Mailing Address - Fax:
Practice Address - Street 1:850 22ND AVE
Practice Address - Street 2:STE 3
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1688
Practice Address - Country:US
Practice Address - Phone:319-358-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV38802Medicare PIN
NVU76030Medicare UPIN
NV38804Medicare PIN