Provider Demographics
NPI:1184881484
Name:MARLA M. ST. JOHN, D.C., P.C.
Entity type:Organization
Organization Name:MARLA M. ST. JOHN, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:MAYE
Authorized Official - Last Name:ST. JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-386-1638
Mailing Address - Street 1:1942 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9542
Mailing Address - Country:US
Mailing Address - Phone:541-386-1638
Mailing Address - Fax:541-408-0614
Practice Address - Street 1:1942 12TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9542
Practice Address - Country:US
Practice Address - Phone:541-386-1638
Practice Address - Fax:541-408-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR039185Medicaid
OR039185Medicaid