Provider Demographics
NPI:1972662195
Name:PANGER, MARILYN J (DC)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:J
Last Name:PANGER
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 1:9045 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3526
Mailing Address - Country:US
Mailing Address - Phone:504-737-2834
Mailing Address - Fax:504-737-4571
Practice Address - Street 1:9045 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-3526
Practice Address - Country:US
Practice Address - Phone:504-737-2834
Practice Address - Fax:504-737-4571
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20185OtherBLUE CROSS BLUE SHIELD
LA20001Medicare UPIN
LA59285Medicare ID - Type Unspecified