Provider Demographics
NPI:1508984311
Name:REDDELL, MARLIN K (DC)
Entity Type:Individual
Prefix:DR
First Name:MARLIN
Middle Name:K
Last Name:REDDELL
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 1:1148 E STEARNS ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6318
Mailing Address - Country:US
Mailing Address - Phone:479-443-3211
Mailing Address - Fax:479-443-3211
Practice Address - Street 1:1148 E STEARNS ST
Practice Address - Street 2:SUITE 4
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6318
Practice Address - Country:US
Practice Address - Phone:479-443-3211
Practice Address - Fax:479-443-3211
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor