Provider Demographics
NPI:1922015619
Name:MARRS, JEFFREY RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RICHARD
Last Name:MARRS
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 1:2091 W FLORIDA AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-4800
Mailing Address - Country:US
Mailing Address - Phone:951-929-0100
Mailing Address - Fax:951-929-0660
Practice Address - Street 1:2091 W FLORIDA AVE
Practice Address - Street 2:STE 120
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-4800
Practice Address - Country:US
Practice Address - Phone:951-929-0100
Practice Address - Fax:951-929-0660
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA24168OtherCA CHIROPRACTIC BOARD
U96921Medicare UPIN
CA24168OtherCA CHIROPRACTIC BOARD