Provider Demographics
NPI:1376611582
Name:MARLEY, JOEL EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:EDWIN
Last Name:MARLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18025 OAK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-6093
Mailing Address - Country:US
Mailing Address - Phone:402-884-4100
Mailing Address - Fax:
Practice Address - Street 1:18025 OAK DRIVE SUITE A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:712-420-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH768-08-06111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025530400Medicaid
NEP00454939OtherRAILROAD MEDICARE
NE09713OtherBC OF NE
NE10025530400Medicaid