Provider Demographics
NPI:1497957682
Name:MARSDEN FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MARSDEN FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-445-3702
Mailing Address - Street 1:3302 W BROADWAY BUSINESS PARK CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0169
Mailing Address - Country:US
Mailing Address - Phone:573-445-3702
Mailing Address - Fax:
Practice Address - Street 1:3302 W BROADWAY BUSINESS PARK CT
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0169
Practice Address - Country:US
Practice Address - Phone:573-445-3702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004027734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO197246OtherBLUE CROSS GROUP PIN
MO00015379Medicare PIN