Provider Demographics
NPI:1093998791
Name:MARCEL, VINCENT R (D C)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:R
Last Name:MARCEL
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 E MAPLE AVE # B
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3411
Mailing Address - Country:US
Mailing Address - Phone:310-546-6863
Mailing Address - Fax:310-333-0763
Practice Address - Street 1:1924 E MAPLE AVE # B
Practice Address - Street 2:SAME
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3411
Practice Address - Country:US
Practice Address - Phone:310-546-6863
Practice Address - Fax:310-333-0763
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor