Provider Demographics
NPI:1700951530
Name:DEAVER, MARCUS LE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:LE
Last Name:DEAVER
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 1:311 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-3414
Mailing Address - Country:US
Mailing Address - Phone:316-321-5433
Mailing Address - Fax:866-405-2794
Practice Address - Street 1:311 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3414
Practice Address - Country:US
Practice Address - Phone:316-321-5433
Practice Address - Fax:866-405-2794
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-00974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor