Provider Demographics
NPI:1477018489
Name:SHAUN MAR DC LLC
Entity Type:Organization
Organization Name:SHAUN MAR DC LLC
Other - Org Name:ELITE CHIROPRACTIC AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-918-2011
Mailing Address - Street 1:135 E CALDERWOOD DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7963
Mailing Address - Country:US
Mailing Address - Phone:208-844-0475
Mailing Address - Fax:
Practice Address - Street 1:135 E CALDERWOOD DR STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7963
Practice Address - Country:US
Practice Address - Phone:208-844-0475
Practice Address - Fax:208-550-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty