Provider Demographics
NPI:1982462867
Name:MARSHALL, DAVLIN JORDAN SR
Entity Type:Individual
Prefix:MR
First Name:DAVLIN
Middle Name:JORDAN
Last Name:MARSHALL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4932 ELYSIAN FIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4009
Mailing Address - Country:US
Mailing Address - Phone:504-610-4809
Mailing Address - Fax:
Practice Address - Street 1:3233 SAINT BERNARD AVE STE B
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-1918
Practice Address - Country:US
Practice Address - Phone:504-610-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347D00000X
LA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No347D00000XTransportation ServicesTrain