Provider Demographics
NPI:1821000829
Name:FISH, MARIAN HALL (DC , DABCO)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:HALL
Last Name:FISH
Suffix:
Gender:F
Credentials:DC , DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1855
Mailing Address - Country:US
Mailing Address - Phone:503-232-8582
Mailing Address - Fax:503-460-0814
Practice Address - Street 1:3241 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1855
Practice Address - Country:US
Practice Address - Phone:503-232-8582
Practice Address - Fax:503-460-0814
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR00WFBWXAMedicare ID - Type Unspecified