Provider Demographics
NPI:1881268332
Name:MARRY, DEVAN ROBERT (DC)
Entity type:Individual
Prefix:
First Name:DEVAN
Middle Name:ROBERT
Last Name:MARRY
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 1:120 N EVANS ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1555
Mailing Address - Country:US
Mailing Address - Phone:517-815-1555
Mailing Address - Fax:517-815-1553
Practice Address - Street 1:120 N EVANS ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1555
Practice Address - Country:US
Practice Address - Phone:517-815-1555
Practice Address - Fax:517-815-1553
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301011101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301011101OtherLARA