Provider Demographics
NPI:1083733398
Name:BOELK, MARISA CAROLINA
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:CAROLINA
Last Name:BOELK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:CAROLINA
Other - Last Name:CONTRERAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:5095 MURPHY CANYON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4348
Mailing Address - Country:US
Mailing Address - Phone:619-298-0800
Mailing Address - Fax:619-298-8080
Practice Address - Street 1:4060 FAIRMOUNT AVE
Practice Address - Street 2:CHIROPRACTIC DEPARTMENT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105
Practice Address - Country:US
Practice Address - Phone:619-798-3947
Practice Address - Fax:619-269-1302
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASAT35706111N00000X
CADC 29340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor