Provider Demographics
NPI:1306118260
Name:MARSHALL, DAVID RAYMOND (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAYMOND
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 CAMINO DEL RIO SOUTH
Mailing Address - Street 2:106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111
Mailing Address - Country:US
Mailing Address - Phone:619-299-9800
Mailing Address - Fax:619-299-9889
Practice Address - Street 1:411 CAMINO DEL RIO S
Practice Address - Street 2:106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3530
Practice Address - Country:US
Practice Address - Phone:619-299-9800
Practice Address - Fax:619-299-9889
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor