Provider Demographics
NPI:1609054931
Name:MARVIN FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MARVIN FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-735-4755
Mailing Address - Street 1:37 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2306
Mailing Address - Country:US
Mailing Address - Phone:845-735-4755
Mailing Address - Fax:845-735-1055
Practice Address - Street 1:37 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2306
Practice Address - Country:US
Practice Address - Phone:845-735-4755
Practice Address - Fax:845-735-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008559-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX91051Medicare PIN
NYX91051Medicare UPIN