Provider Demographics
NPI:1952394637
Name:MARSHALL, ERIC JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOHN
Last Name:MARSHALL
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 1:1605 FRED MOORE HWY
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-5296
Mailing Address - Country:US
Mailing Address - Phone:810-329-6100
Mailing Address - Fax:810-329-8650
Practice Address - Street 1:1605 FRED MOORE HWY
Practice Address - Street 2:
Practice Address - City:ST CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5296
Practice Address - Country:US
Practice Address - Phone:810-329-6100
Practice Address - Fax:810-329-8650
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3326787Medicaid
MIOM35010Medicare ID - Type Unspecified
MI3326787Medicaid