Provider Demographics
NPI:1871537316
Name:HINES, MARK EVERETT (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EVERETT
Last Name:HINES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:EVERETT
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40011-1467
Mailing Address - Country:US
Mailing Address - Phone:502-532-0099
Mailing Address - Fax:502-532-0096
Practice Address - Street 1:8172 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CAMPBELLSBURG
Practice Address - State:KY
Practice Address - Zip Code:40011-1467
Practice Address - Country:US
Practice Address - Phone:502-532-0099
Practice Address - Fax:502-532-0096
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY248871111N00000X
KY4721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003598Medicaid
KY85003598Medicaid
KY6104801Medicare PIN