Provider Demographics
NPI:1710275052
Name:MARBACH, ERICA MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:MARTIN
Last Name:MARBACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:MARTIN
Other - Last Name:MIRELES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5220 CLARK AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2618
Mailing Address - Country:US
Mailing Address - Phone:562-925-6825
Mailing Address - Fax:801-925-6825
Practice Address - Street 1:5220 CLARK AVE
Practice Address - Street 2:STE 320
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2618
Practice Address - Country:US
Practice Address - Phone:562-925-6825
Practice Address - Fax:801-925-6825
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor