Provider Demographics
NPI:1528112463
Name:MARCON, DAVID J (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:MARCON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2608
Mailing Address - Country:US
Mailing Address - Phone:513-474-1111
Mailing Address - Fax:513-474-1984
Practice Address - Street 1:1971 8 MILE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2608
Practice Address - Country:US
Practice Address - Phone:513-474-1111
Practice Address - Fax:513-474-1984
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC2125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2491030Medicaid
OH2491030Medicaid
OHMA4125651Medicare ID - Type Unspecified