Provider Demographics
NPI:1619032414
Name:DREESSEN, MARVIN DUANE (DC)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:DUANE
Last Name:DREESSEN
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 1:2068 SE SEDGWICK ROAD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-9502
Mailing Address - Country:US
Mailing Address - Phone:360-876-2550
Mailing Address - Fax:360-876-2556
Practice Address - Street 1:2068 SE SEDGWICK ROAD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-9502
Practice Address - Country:US
Practice Address - Phone:360-876-2550
Practice Address - Fax:360-876-2556
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00913501OtherGROUP HEALTH
WA12646OtherDEPT OF L&I
WA2237501Medicaid
WA2237501Medicaid
T02160Medicare UPIN