Provider Demographics
NPI:1437103140
Name:OBBINK, MARC RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:RYAN
Last Name:OBBINK
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 1:4716 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-3020
Mailing Address - Country:US
Mailing Address - Phone:712-276-0712
Mailing Address - Fax:712-276-0718
Practice Address - Street 1:4716 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-3020
Practice Address - Country:US
Practice Address - Phone:712-276-0712
Practice Address - Fax:712-276-0718
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0472175Medicaid
IAV08475Medicare UPIN
IAI19981Medicare PIN