Provider Demographics
NPI:1285828418
Name:MARIAN, JOHN (D C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MARIAN
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 1:14375 SARATOGA AVE.
Mailing Address - Street 2:SARATOGA
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5978
Mailing Address - Country:US
Mailing Address - Phone:408-872-1031
Mailing Address - Fax:408-872-1074
Practice Address - Street 1:14375 SARATOGA AVE.
Practice Address - Street 2:SARATOGA
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5978
Practice Address - Country:US
Practice Address - Phone:408-872-1031
Practice Address - Fax:408-872-1074
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU94715Medicare UPIN