Provider Demographics
NPI:1912981580
Name:PRADA, MARSHA D (DC)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:D
Last Name:PRADA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:D
Other - Last Name:DIRKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3490 YOUNGFIELD ST
Mailing Address - Street 2:STE B
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5284
Mailing Address - Country:US
Mailing Address - Phone:303-274-4434
Mailing Address - Fax:303-274-4441
Practice Address - Street 1:3490 YOUNGFIELD ST
Practice Address - Street 2:STE B
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5284
Practice Address - Country:US
Practice Address - Phone:303-274-4434
Practice Address - Fax:303-274-4441
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2972111N00000X
CO5934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U56684Medicare UPIN
109102Medicare ID - Type Unspecified