Provider Demographics
NPI:1437557931
Name:TOLJ, MARIJAN MARIO (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIJAN
Middle Name:MARIO
Last Name:TOLJ
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 1:1180 GLEN ARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE ROCK
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2520
Mailing Address - Country:US
Mailing Address - Phone:626-500-5868
Mailing Address - Fax:
Practice Address - Street 1:4444 LANKERSHIM BLVD STE 104
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2346
Practice Address - Country:US
Practice Address - Phone:818-509-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32892111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician