Provider Demographics
NPI:1801896790
Name:STONE, MARK PHILIP (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:PHILIP
Last Name:STONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:51 DEPOT ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2629
Mailing Address - Country:US
Mailing Address - Phone:860-274-5484
Mailing Address - Fax:860-274-4923
Practice Address - Street 1:51 DEPOT ST
Practice Address - Street 2:SUITE 504
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2629
Practice Address - Country:US
Practice Address - Phone:860-274-5484
Practice Address - Fax:860-274-4923
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT60054Medicare UPIN
CT736535Medicare UPIN
CT050000692CT01Medicare UPIN
CTP2749234Medicare UPIN
CT2158223Medicare UPIN