Provider Demographics
NPI:1811711450
Name:MARRIN, MAVERICK (DC)
Entity type:Individual
Prefix:
First Name:MAVERICK
Middle Name:
Last Name:MARRIN
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 1:518 MONROE TPKE STE A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2358
Mailing Address - Country:US
Mailing Address - Phone:203-452-0799
Mailing Address - Fax:
Practice Address - Street 1:518 MONROE TPKE STE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2358
Practice Address - Country:US
Practice Address - Phone:203-452-0799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor