Provider Demographics
NPI:1871606012
Name:PEPIN, MARK STEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:PEPIN
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 1:9044 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1928
Mailing Address - Country:US
Mailing Address - Phone:305-255-2499
Mailing Address - Fax:305-252-9849
Practice Address - Street 1:9044 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1928
Practice Address - Country:US
Practice Address - Phone:305-255-2499
Practice Address - Fax:305-252-9849
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006601111NI0900X
FLCH6601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NI0900XChiropractic ProvidersChiropractorInternist
Not Answered111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55176OtherJMH
FL657081OtherACN/UNITED HEATHCARE
FLU45794Medicare UPIN
FL22932Medicare ID - Type UnspecifiedMEDICARE