Provider Demographics
NPI:1134318264
Name:MARSH PC DBA SPCC MT LAUREL
Entity Type:Organization
Organization Name:MARSH PC DBA SPCC MT LAUREL
Other - Org Name:MARSH PC DBA SPCC MT LAUREL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DIETRICH-MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-437-8837
Mailing Address - Street 1:50 MANNING PL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-1809
Mailing Address - Country:US
Mailing Address - Phone:205-437-8837
Mailing Address - Fax:205-437-3705
Practice Address - Street 1:50 MANNING PL
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-1809
Practice Address - Country:US
Practice Address - Phone:205-437-8837
Practice Address - Fax:205-437-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty