Provider Demographics
NPI:1689624298
Name:MARSHALL, MARC (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:MARSHALL
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 1:443 HOPE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1660
Mailing Address - Country:US
Mailing Address - Phone:401-354-2927
Mailing Address - Fax:
Practice Address - Street 1:443 HOPE ST APT 2
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1660
Practice Address - Country:US
Practice Address - Phone:401-354-2927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004370111N00000X
MA1046111N00000X
RIDCP00440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY4529901Medicare UPIN