Provider Demographics
NPI:1316159049
Name:MARZAN, ELLEN (DC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:MARZAN
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 1:100 ZIRCON CT
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 SYCAMORE AVE
Practice Address - Street 2:SUITE B14
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1775
Practice Address - Country:US
Practice Address - Phone:510-799-3760
Practice Address - Fax:510-799-3744
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor