Provider Demographics
NPI:1417099896
Name:ORTH, MARILYN JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:JEAN
Last Name:ORTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:JOHN
Other - Middle Name:THOMAS
Other - Last Name:ORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:33062 CR 25
Mailing Address - Street 2:DR MARILYN J ORTH
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-9326
Mailing Address - Country:US
Mailing Address - Phone:970-686-1461
Mailing Address - Fax:
Practice Address - Street 1:33062 CR 25
Practice Address - Street 2:CROSS ROADS CHIROPRACTIC
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-9326
Practice Address - Country:US
Practice Address - Phone:970-686-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO828421OtherCHC (FIRST HEALTH)
CO156919XXOtherPREFERRED CARE
CO828421OtherCHC (FIRST HEALTH)
CO29063Medicare ID - Type Unspecified