Provider Demographics
NPI:1508055484
Name:MARCOTTE, ERIC DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DANIEL
Last Name:MARCOTTE
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 1:13927 W GRAND AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2438
Mailing Address - Country:US
Mailing Address - Phone:623-544-1920
Mailing Address - Fax:
Practice Address - Street 1:13927 W GRAND AVE STE 402
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2438
Practice Address - Country:US
Practice Address - Phone:623-544-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor