Provider Demographics
NPI:1265431761
Name:MARIEN, MARK CRESTON (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CRESTON
Last Name:MARIEN
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 1:19315 WEST CATAWBA AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031
Mailing Address - Country:US
Mailing Address - Phone:704-896-1811
Mailing Address - Fax:239-542-8193
Practice Address - Street 1:19315 W CATAWBA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8650
Practice Address - Country:US
Practice Address - Phone:704-896-1811
Practice Address - Fax:239-542-8193
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9058111N00000X
NC4334111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70040OtherBLUE CROSS
FLV06257Medicare UPIN
FL70040AMedicare PIN