Provider Demographics
NPI:1871678169
Name:MARLATT, JEFFREY M (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:MARLATT
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 1:11837 WILCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-1919
Mailing Address - Country:US
Mailing Address - Phone:281-495-2225
Mailing Address - Fax:281-495-3945
Practice Address - Street 1:11837 WILCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-1919
Practice Address - Country:US
Practice Address - Phone:281-495-2225
Practice Address - Fax:281-495-3945
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603929Medicaid
TX603929Medicaid
TX603929Medicare ID - Type Unspecified