Provider Demographics
NPI:1528147535
Name:FERNALD, MARVYN C (DC)
Entity type:Individual
Prefix:DR
First Name:MARVYN
Middle Name:C
Last Name:FERNALD
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 1:1800 SOUTH MAIN
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-5441
Mailing Address - Country:US
Mailing Address - Phone:956-631-0142
Mailing Address - Fax:956-618-0446
Practice Address - Street 1:1800 SOUTH MAIN
Practice Address - Street 2:SUITE 450
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-5441
Practice Address - Country:US
Practice Address - Phone:956-631-0142
Practice Address - Fax:956-618-0446
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC9156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC9156OtherLICENCE NUMBER
TX8K8464OtherBCBS PROVIDER NUMBER
TXDC9156OtherLICENCE NUMBER
TX610786Medicare ID - Type UnspecifiedMEDICARE