Provider Demographics
NPI:1972937712
Name:MARIN, JUAN CARLOS (DC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:MARIN
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 1:2221 KING CT UNIT 31
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5179
Mailing Address - Country:US
Mailing Address - Phone:563-542-4596
Mailing Address - Fax:
Practice Address - Street 1:1428 PHILLIPS LN STE 300
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2552
Practice Address - Country:US
Practice Address - Phone:805-543-8688
Practice Address - Fax:805-543-8732
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012440111N00000X
CA33745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor