1467638213 NPI number — JUSTINE M. MARCUS DC LLC

Table of content: (NPI 1467638213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467638213 NPI number — JUSTINE M. MARCUS DC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUSTINE M. MARCUS DC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAUREL CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467638213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11695 ROUTE 56 HWY E
Provider Second Line Business Mailing Address:
PO BOX 166
Provider Business Mailing Address City Name:
ARMAGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15920-9025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-446-5555
Provider Business Mailing Address Fax Number:
814-446-4147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11695 ROUTE 56 HWY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARMAGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15920-9025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-446-5555
Provider Business Practice Location Address Fax Number:
814-446-4147
Provider Enumeration Date:
01/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARCUS
Authorized Official First Name:
JUSTINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
814-446-5555

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC009874 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)