Provider Demographics
NPI:1760474415
Name:WELCH, MARLA LARIMER (DC)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:LARIMER
Last Name:WELCH
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 1:1101 STANDIFORD AVE
Mailing Address - Street 2:STE A6
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0982
Mailing Address - Country:US
Mailing Address - Phone:209-522-0822
Mailing Address - Fax:209-522-4563
Practice Address - Street 1:1101 STANDIFORD AVE
Practice Address - Street 2:STE A6
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0982
Practice Address - Country:US
Practice Address - Phone:209-522-0822
Practice Address - Fax:209-522-4563
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ61519ZOtherBLUE SHIELD
CAT05514Medicare UPIN
CAZZZ61519ZOtherBLUE SHIELD