Provider Demographics
NPI:1033321096
Name:MARLOW, JOHN DERRICK (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DERRICK
Last Name:MARLOW
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 1:6642 PENN AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2026
Mailing Address - Country:US
Mailing Address - Phone:612-861-2752
Mailing Address - Fax:612-861-2752
Practice Address - Street 1:6642 PENN AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2026
Practice Address - Country:US
Practice Address - Phone:612-861-2752
Practice Address - Fax:612-861-2752
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C298MAOtherBLUE CROSS PROVIDER
MN4C297S0OtherBLUE CROSS CLINIC NUMBER