Provider Demographics
NPI:1154335552
Name:MARSE, ANDRE ALPHONSE (DC)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:ALPHONSE
Last Name:MARSE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2901 ACME BRICK PLZ # 201
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4124
Mailing Address - Country:US
Mailing Address - Phone:817-882-6754
Mailing Address - Fax:817-887-1222
Practice Address - Street 1:2901 ACME BRICK PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4124
Practice Address - Country:US
Practice Address - Phone:817-882-6754
Practice Address - Fax:817-887-1222
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1384111N00000X
TX11483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H755BC77Medicare PIN