Provider Demographics
NPI:1811098056
Name:MASON, MARIE H (DC)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:H
Last Name:MASON
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 1:17921 NE CRAMER RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-6123
Mailing Address - Country:US
Mailing Address - Phone:360-723-0025
Mailing Address - Fax:
Practice Address - Street 1:1748 NW FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3842
Practice Address - Country:US
Practice Address - Phone:503-492-3910
Practice Address - Fax:503-674-6706
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034565111N00000X
OR5019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor