Provider Demographics
NPI:1437335270
Name:AGER, DAVID MARSHALL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARSHALL
Last Name:AGER
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:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-0159
Mailing Address - Country:US
Mailing Address - Phone:541-880-3330
Mailing Address - Fax:
Practice Address - Street 1:100 N D ST STE 206
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-1553
Practice Address - Country:US
Practice Address - Phone:541-880-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR168594Medicare PIN