Provider Demographics
NPI:1598254682
Name:OVERSTREET, MARCUS EVANS (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:EVANS
Last Name:OVERSTREET
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 1:301 E 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-1424
Mailing Address - Country:US
Mailing Address - Phone:229-273-1878
Mailing Address - Fax:229-513-3194
Practice Address - Street 1:301 E 14TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-1424
Practice Address - Country:US
Practice Address - Phone:229-273-1878
Practice Address - Fax:229-513-3194
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor