Provider Demographics
NPI:1306260765
Name:GRAVEL, MARIE NATHALIE FRANCE (DC)
Entity type:Individual
Prefix:
First Name:MARIE NATHALIE
Middle Name:FRANCE
Last Name:GRAVEL
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 1:4936 SW 60TH PL
Mailing Address - Street 2:APT #1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4936 SW 60TH PL
Practice Address - Street 2:APT #1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-1146
Practice Address - Country:US
Practice Address - Phone:503-270-1693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor