Provider Demographics
NPI:1689736001
Name:SAUNDERS, MARLENE KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:KAY
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-2060
Mailing Address - Country:US
Mailing Address - Phone:208-245-3420
Mailing Address - Fax:208-245-3420
Practice Address - Street 1:533 MAIN AVE
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-2060
Practice Address - Country:US
Practice Address - Phone:208-245-3420
Practice Address - Fax:208-245-3420
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000186400Medicaid
ID000010008524OtherREGENCE BLUE SHIELD
IDC527-9OtherBLUE CROSS
ID1672046Medicare ID - Type Unspecified