Provider Demographics
NPI:1679954044
Name:DEICHMAN, MARK GARREN (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:GARREN
Last Name:DEICHMAN
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 1:76 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1500
Mailing Address - Country:US
Mailing Address - Phone:803-259-9412
Mailing Address - Fax:803-259-0559
Practice Address - Street 1:76 IRVING ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1500
Practice Address - Country:US
Practice Address - Phone:803-259-9412
Practice Address - Fax:803-259-0559
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor