Provider Demographics
NPI:1699766337
Name:MARSHALL, DONALD MIKAEL (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MIKAEL
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:D.
Other - Middle Name:M
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3998 S DANVILLE BYP
Mailing Address - Street 2:STE 102
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2538
Mailing Address - Country:US
Mailing Address - Phone:859-236-5129
Mailing Address - Fax:859-236-2867
Practice Address - Street 1:3998 S DANVILLE BYP
Practice Address - Street 2:STE 102
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2538
Practice Address - Country:US
Practice Address - Phone:859-236-5129
Practice Address - Fax:859-236-2867
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYT41910Medicare UPIN
KY0965802Medicare ID - Type Unspecified