Provider Demographics
NPI:1295103596
Name:MARSH, KENNETH
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:MARSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2514
Mailing Address - Country:US
Mailing Address - Phone:419-224-5678
Mailing Address - Fax:419-221-3340
Practice Address - Street 1:3075 W ELM ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2514
Practice Address - Country:US
Practice Address - Phone:419-224-5678
Practice Address - Fax:419-221-3340
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor