Provider Demographics
NPI:1912000571
Name:SIEMENS, MARC DOUGLAS (DC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:DOUGLAS
Last Name:SIEMENS
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 1:5705 MARCONI AVE
Mailing Address - Street 2:STE B
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95660
Mailing Address - Country:US
Mailing Address - Phone:916-487-5555
Mailing Address - Fax:916-483-0329
Practice Address - Street 1:5705 MARCONI AVE
Practice Address - Street 2:STE B
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95660
Practice Address - Country:US
Practice Address - Phone:916-487-5555
Practice Address - Fax:916-483-0329
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80713Medicare UPIN