Provider Demographics
NPI:1649327800
Name:ESCHBACH, MARK MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:MICHAEL
Last Name:ESCHBACH
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:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98577-0089
Mailing Address - Country:US
Mailing Address - Phone:360-942-2414
Mailing Address - Fax:
Practice Address - Street 1:326 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577-2416
Practice Address - Country:US
Practice Address - Phone:360-942-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA18219OtherL&I NUMBER
WAES5713OtherREGENCE NUMBER
WA18219OtherL&I NUMBER
WAABO5887Medicare ID - Type UnspecifiedMEDICARE NUMBER