Individual
DR. MARK C. REPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
16470 5TH ST N, LAKELAND, MN 55043-9548
(651) 436-6877
Mailing address
16470 5TH ST N, LAKELAND, MN 55043-9548
(651) 436-6877
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1670
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01B53RE
BC CONTRACTING PROV. ID
MN
01
—
01B54RE
BLUE CROSS INDIV NUMBER
MN
01
—
44-53979
MEDICA
—
Enumeration date
11/28/2005
Last updated
12/17/2007
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