Provider Demographics
NPI:1588815807
Name:MARR, BEVERLEY A (DC)
Entity Type:Individual
Prefix:DR
First Name:BEVERLEY
Middle Name:A
Last Name:MARR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1804
Mailing Address - Country:US
Mailing Address - Phone:203-452-1110
Mailing Address - Fax:
Practice Address - Street 1:22 5TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5030
Practice Address - Country:US
Practice Address - Phone:203-569-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001137OtherLICENSE NUMBER