Provider Demographics
NPI:1114954930
Name:COLBURN, MARLA J (DC)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:J
Last Name:COLBURN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4719
Mailing Address - Country:US
Mailing Address - Phone:860-730-2996
Mailing Address - Fax:
Practice Address - Street 1:310 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4719
Practice Address - Country:US
Practice Address - Phone:860-730-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350001400Medicare ID - Type Unspecified
V01235Medicare UPIN