Provider Demographics
NPI:1558367078
Name:MARVEL, MICHAEL V (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:MARVEL
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 1:624 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-5828
Mailing Address - Country:US
Mailing Address - Phone:870-365-0071
Mailing Address - Fax:870-365-0075
Practice Address - Street 1:200 HWY 43 EAST
Practice Address - Street 2:STE Z
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:870-365-0071
Practice Address - Fax:870-365-0075
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152082718Medicaid
ARU89864Medicare UPIN