Provider Demographics
NPI:1073505236
Name:MARSH, PAUL JONATHAN (DC , QME)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JONATHAN
Last Name:MARSH
Suffix:
Gender:M
Credentials:DC , QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 TEXAS ST
Mailing Address - Street 2:#301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3721
Mailing Address - Country:US
Mailing Address - Phone:619-299-1993
Mailing Address - Fax:619-296-7647
Practice Address - Street 1:5005 TEXAS ST
Practice Address - Street 2:#301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3721
Practice Address - Country:US
Practice Address - Phone:619-299-1993
Practice Address - Fax:619-296-7647
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25082111N00000X, 111NS0005X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC25082AMedicare ID - Type Unspecified