Provider Demographics
NPI:1700540176
Name:GARCIA, MARYLOU MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARYLOU
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N OSBORN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-1834
Mailing Address - Country:US
Mailing Address - Phone:626-222-2556
Mailing Address - Fax:
Practice Address - Street 1:2472 CHAMBERS RD STE 120
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6954
Practice Address - Country:US
Practice Address - Phone:626-222-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor