Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 3441 | WI |
NPI | 1063483048 |
---|---|
Provider Name | Dr. Mark S Edinger |
First Address | Ripon, WI 54971-1192 |
Second Address | Ripon, WI 54971-1192 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 07/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38901800 | (05) | WI |
391431452013 | BLUE CROSS (01) | WI |
U65822 | (02) | WI |