Provider Demographics
NPI:1285704189
Name:TRUJILLO, MARCELA (DC)
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 MAIN ST STE 14
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9102
Mailing Address - Country:US
Mailing Address - Phone:530-622-1234
Mailing Address - Fax:530-622-4246
Practice Address - Street 1:484 MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9102
Practice Address - Country:US
Practice Address - Phone:530-622-1234
Practice Address - Fax:530-622-4246
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29543OtherLICENCE NUMBER
CADC0295430Medicare ID - Type Unspecified