Provider Demographics
NPI:1023337383
Name:MARIN, GREGORY (DC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:MARIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:MARIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5224 75TH SUITE B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2525
Mailing Address - Country:US
Mailing Address - Phone:806-771-9357
Mailing Address - Fax:
Practice Address - Street 1:1003 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336
Practice Address - Country:US
Practice Address - Phone:806-894-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367421YY3LMedicare PIN
TX367421ZN8VMedicare PIN