Provider Demographics
NPI:1801909262
Name:MARSHALL, RONDA (DC)
Entity type:Individual
Prefix:DR
First Name:RONDA
Middle Name:
Last Name:MARSHALL
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 1:4345 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4031
Mailing Address - Country:US
Mailing Address - Phone:248-342-7452
Mailing Address - Fax:
Practice Address - Street 1:3093 SASHABAW RD
Practice Address - Street 2:SUITE B
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4089
Practice Address - Country:US
Practice Address - Phone:248-674-4898
Practice Address - Fax:248-674-4905
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP37040Medicare ID - Type Unspecified