Provider Demographics
NPI:1427001478
Name:HOSTETLER, MARCUS RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:RAY
Last Name:HOSTETLER
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 1:3750 SAVANNAH HWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-7909
Mailing Address - Country:US
Mailing Address - Phone:843-766-1501
Mailing Address - Fax:843-578-0628
Practice Address - Street 1:3750 SAVANNAH HWY
Practice Address - Street 2:SUITE G
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-7909
Practice Address - Country:US
Practice Address - Phone:843-766-1501
Practice Address - Fax:843-578-0628
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2744Medicaid
SCGCH471Medicaid
SCAA06788098Medicare ID - Type UnspecifiedCMS PROVIDER #
SCGCH471Medicaid