Provider Demographics
NPI:1316186786
Name:MARR PHYSICAL MEDICINE PAIN AND INJURY CENTER
Entity Type:Organization
Organization Name:MARR PHYSICAL MEDICINE PAIN AND INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-554-5575
Mailing Address - Street 1:3480 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1826
Mailing Address - Country:US
Mailing Address - Phone:281-554-5575
Mailing Address - Fax:281-557-8925
Practice Address - Street 1:3480 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-1826
Practice Address - Country:US
Practice Address - Phone:281-554-5575
Practice Address - Fax:281-557-8925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. GLENN MARR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1225255045OtherNPI