Provider Demographics
NPI:1659506483
Name:PAUL J MARSH CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:PAUL J MARSH CHIROPRACTIC CORPORATION
Other - Org Name:DR. PAUL J. MARSH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, QME
Authorized Official - Phone:619-299-1993
Mailing Address - Street 1:5005 TEXAS ST
Mailing Address - Street 2:STE 301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3721
Mailing Address - Country:US
Mailing Address - Phone:619-299-1993
Mailing Address - Fax:619-296-7647
Practice Address - Street 1:5005 TEXAS ST STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3724
Practice Address - Country:US
Practice Address - Phone:619-299-1993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18229Medicare PIN