Provider Demographics
NPI:1346293032
Name:MARSH, GWEN MICHELE (DC)
Entity Type:Individual
Prefix:DR
First Name:GWEN
Middle Name:MICHELE
Last Name:MARSH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:GWEN
Other - Middle Name:MICHELE
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:9413 NE HWY 99
Mailing Address - Street 2:STE 1
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8947
Mailing Address - Country:US
Mailing Address - Phone:360-574-7705
Mailing Address - Fax:360-574-3307
Practice Address - Street 1:9413 NE HWY 99
Practice Address - Street 2:STE 1
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8947
Practice Address - Country:US
Practice Address - Phone:360-574-7705
Practice Address - Fax:360-574-3307
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor