Provider Demographics
NPI:1255466173
Name:MARCUM CHIROPRACTIC
Entity type:Organization
Organization Name:MARCUM CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-234-7130
Mailing Address - Street 1:12425 NE GLISAN ST STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2144
Mailing Address - Country:US
Mailing Address - Phone:503-234-7130
Mailing Address - Fax:503-235-7134
Practice Address - Street 1:12425 NE GLISAN ST STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2144
Practice Address - Country:US
Practice Address - Phone:503-234-7130
Practice Address - Fax:503-235-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty