Provider Demographics
NPI:1720256175
Name:ETTINGER, MARCUS STEWART (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:STEWART
Last Name:ETTINGER
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 1:29740 CAMINO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2113
Mailing Address - Country:US
Mailing Address - Phone:951-308-1962
Mailing Address - Fax:
Practice Address - Street 1:29740 CAMINO DEL SOL
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2113
Practice Address - Country:US
Practice Address - Phone:951-308-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor