Provider Demographics
NPI:1184751869
Name:MARR, MATTHEW JOHN (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:MARR
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 1:201 GREAT OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9430
Mailing Address - Country:US
Mailing Address - Phone:330-336-9500
Mailing Address - Fax:330-336-3377
Practice Address - Street 1:201 GREAT OAKS TRL
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9430
Practice Address - Country:US
Practice Address - Phone:330-336-9500
Practice Address - Fax:330-336-3377
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4093111N00000X
PADC009764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084598Medicaid