Provider Demographics
NPI:1861694085
Name:PRATHER, MARK (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PRATHER
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:2565 S ROCHESTER RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4472
Mailing Address - Country:US
Mailing Address - Phone:586-299-8900
Mailing Address - Fax:586-299-8923
Practice Address - Street 1:2565 S ROCHESTER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4472
Practice Address - Country:US
Practice Address - Phone:586-299-8900
Practice Address - Fax:586-299-8923
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2009-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI2301006709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP61640001Medicare PIN