Provider Demographics
NPI:1316107279
Name:MARVEL, MICHELLE D (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:D
Last Name:MARVEL
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 1:607 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2537
Mailing Address - Country:US
Mailing Address - Phone:618-937-3509
Mailing Address - Fax:618-937-3500
Practice Address - Street 1:607 W OAK ST
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2537
Practice Address - Country:US
Practice Address - Phone:618-937-3509
Practice Address - Fax:618-937-3500
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor