Provider Demographics
NPI:1447433685
Name:FEDORCZYK, MARK (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:FEDORCZYK
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 1:1005 CHERYLS CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8400
Mailing Address - Country:US
Mailing Address - Phone:240-357-0342
Mailing Address - Fax:301-696-0114
Practice Address - Street 1:1050 KEY PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4056
Practice Address - Country:US
Practice Address - Phone:301-846-2273
Practice Address - Fax:301-620-2273
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor