Provider Demographics
NPI:1609870146
Name:MARSH, JOHN L (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:MARSH
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 1:8910 BANDERA RD
Mailing Address - Street 2:STE 302
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-3224
Mailing Address - Country:US
Mailing Address - Phone:210-684-6932
Mailing Address - Fax:210-521-1995
Practice Address - Street 1:8910 BANDERA RD
Practice Address - Street 2:STE 302
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-3224
Practice Address - Country:US
Practice Address - Phone:210-684-6932
Practice Address - Fax:210-521-1995
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609819Medicare ID - Type Unspecified
TXU94913Medicare UPIN