Provider Demographics
NPI:1427357151
Name:MARRS CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:MARRS CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-929-0100
Mailing Address - Street 1:2091 W FLORIDA AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-4800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2091 W FLORIDA AVE
Practice Address - Street 2:STE 120
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-4800
Practice Address - Country:US
Practice Address - Phone:951-929-0100
Practice Address - Fax:951-929-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU96921Medicare UPIN
CADC0241680Medicare PIN