Provider Demographics
NPI:1952479867
Name:MARCUM, DALE R (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:R
Last Name:MARCUM
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 1:12425 NE GLISAN ST STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2144
Mailing Address - Country:US
Mailing Address - Phone:503-235-7130
Mailing Address - Fax:
Practice Address - Street 1:12425 NE GLISAN ST STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2144
Practice Address - Country:US
Practice Address - Phone:503-235-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor