Provider Demographics
NPI:1700886199
Name:GOTTLIEB, MARC S (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:S
Last Name:GOTTLIEB
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 1:9380 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2412
Mailing Address - Country:US
Mailing Address - Phone:919-870-9500
Mailing Address - Fax:919-870-9502
Practice Address - Street 1:9380 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2412
Practice Address - Country:US
Practice Address - Phone:919-870-9500
Practice Address - Fax:919-870-9502
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2015-09-03
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
NC2081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2558765Medicare PIN
NCU53031Medicare UPIN
NC2448765Medicare ID - Type Unspecified