Provider Demographics
NPI:1316029994
Name:MARION, LORRETTE ALICE (DC)
Entity type:Individual
Prefix:DR
First Name:LORRETTE
Middle Name:ALICE
Last Name:MARION
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 1:125 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2801
Mailing Address - Country:US
Mailing Address - Phone:413-733-7399
Mailing Address - Fax:
Practice Address - Street 1:125 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2801
Practice Address - Country:US
Practice Address - Phone:413-733-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA947111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35649Medicare ID - Type Unspecified