Provider Demographics
NPI:1225213051
Name:ELLEN A. MARZAN CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:ELLEN A. MARZAN CHIROPRACTIC, INC.
Other - Org Name:FAMILY CHIROPRACTIC JOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-724-2222
Mailing Address - Street 1:1690 SAN PABLO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2073
Mailing Address - Country:US
Mailing Address - Phone:510-724-2222
Mailing Address - Fax:510-724-2227
Practice Address - Street 1:1690 SAN PABLO AVE STE C
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2073
Practice Address - Country:US
Practice Address - Phone:510-724-2222
Practice Address - Fax:510-724-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29801305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service