Provider Demographics
NPI:1871696070
Name:BREIDING, MARK (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BREIDING
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 1:38 CRESTON WAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2735
Mailing Address - Country:US
Mailing Address - Phone:401-529-7772
Mailing Address - Fax:401-886-4506
Practice Address - Street 1:5544 POST RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3459
Practice Address - Country:US
Practice Address - Phone:401-884-8687
Practice Address - Fax:401-886-4506
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI44-00621OtherUNITED HEALTH CARE
RI2534160OtherAETNA
RI26384-1OtherBC/BS OF RI
RIMULTIPLANOtherP-12007098
RI720116401OtherCIGNA
RI44-00621OtherUNITED HEALTH CARE
RI359022242Medicare ID - Type Unspecified