Provider Demographics
NPI:1922270164
Name:COADY, MARILYN JOYCE (DC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:JOYCE
Last Name:COADY
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 1:4530 N LOVINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1011
Mailing Address - Country:US
Mailing Address - Phone:575-392-9004
Mailing Address - Fax:575-392-1370
Practice Address - Street 1:4530 N LOVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1011
Practice Address - Country:US
Practice Address - Phone:575-392-9004
Practice Address - Fax:575-392-1370
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2672395Medicare UPIN