Provider Demographics
NPI:1609979699
Name:MORITZ, MARLON L (DC)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:L
Last Name:MORITZ
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:PO BOX 504
Mailing Address - Street 2:206 N CHURCH ST
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344
Mailing Address - Country:US
Mailing Address - Phone:937-846-1295
Mailing Address - Fax:937-845-5904
Practice Address - Street 1:206 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:40344-0504
Practice Address - Country:US
Practice Address - Phone:937-846-1295
Practice Address - Fax:937-845-5904
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0951895Medicaid
OH0951895Medicaid
OHMA0667511Medicare ID - Type Unspecified
U17033Medicare UPIN