Provider Demographics
NPI:1043456080
Name:TROTTER, MARC DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:DAVID
Last Name:TROTTER
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 1:588 STATE ROUTE 10 WEST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2056
Mailing Address - Country:US
Mailing Address - Phone:973-366-6615
Mailing Address - Fax:973-366-9427
Practice Address - Street 1:588 STATE ROUTE 10 WEST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2056
Practice Address - Country:US
Practice Address - Phone:973-366-6615
Practice Address - Fax:973-366-9427
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00583200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor