Provider Demographics
NPI:1649647330
Name:MARSH, NATHAN LYLE (DC)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:LYLE
Last Name:MARSH
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 1:705 EWALD AVENUE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3404
Mailing Address - Country:US
Mailing Address - Phone:503-378-0068
Mailing Address - Fax:503-378-0069
Practice Address - Street 1:705 EWALD AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3403
Practice Address - Country:US
Practice Address - Phone:503-378-0068
Practice Address - Fax:503-378-0069
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor