Provider Demographics
NPI:1306088653
Name:BOBROW, MARC ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:ANTHONY
Last Name:BOBROW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1758
Mailing Address - Country:US
Mailing Address - Phone:502-995-0099
Mailing Address - Fax:502-449-1280
Practice Address - Street 1:5209 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1758
Practice Address - Country:US
Practice Address - Phone:502-995-0099
Practice Address - Fax:502-449-1280
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50030081Medicaid
KY7100131040Medicaid