Provider Demographics
NPI:1023189628
Name:MARSHALL, DANIEL E (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:MARSHALL
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 1:12482 SW 131ST AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7819
Mailing Address - Country:US
Mailing Address - Phone:503-598-7652
Mailing Address - Fax:503-598-7653
Practice Address - Street 1:12482 SW 131ST AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-7819
Practice Address - Country:US
Practice Address - Phone:503-598-7652
Practice Address - Fax:503-598-7653
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2021-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101132Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ORU38576Medicare UPIN