Provider Demographics
NPI:1134345804
Name:MOBLEY, MARCUS CHRISTIAN (DC)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:CHRISTIAN
Last Name:MOBLEY
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 1:3111 FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-2546
Mailing Address - Country:US
Mailing Address - Phone:256-766-2828
Mailing Address - Fax:
Practice Address - Street 1:3111 FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634-2546
Practice Address - Country:US
Practice Address - Phone:256-766-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-73427OtherBLUE CROSS BLUE SHIELD
AL510-73427OtherBLUE CROSS BLUE SHIELD