1821205337 NPI number — DR. MARC A FERRIN D.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821205337 NPI number — DR. MARC A FERRIN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRIN
Provider First Name:
MARC
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1821205337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2707 W. EDGEWOOD DR.
Provider Second Line Business Mailing Address:
STE. 104
Provider Business Mailing Address City Name:
JEFFERSON CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-893-9800
Provider Business Mailing Address Fax Number:
888-335-8965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2707 W EDGEWOOD DR STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65109-5886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-893-9800
Provider Business Practice Location Address Fax Number:
888-335-8965
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00033961 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 2009001038 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0157660 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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