Provider Demographics
NPI:1013174002
Name:SZCZURAK, MARIE ANGELINE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:ANGELINE
Last Name:SZCZURAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:ANGELINE
Other - Last Name:SZCZURAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:5301 LAUREL CANYON BLVD
Mailing Address - Street 2:#120
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2736
Mailing Address - Country:US
Mailing Address - Phone:310-854-4266
Mailing Address - Fax:
Practice Address - Street 1:5301 LAUREL CANYON BLVD
Practice Address - Street 2:#120
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2736
Practice Address - Country:US
Practice Address - Phone:310-854-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 22870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22870OtherBOARD OF CHIROPRACTIC EXAMINERS