Provider Demographics
NPI:1912174723
Name:MARQUEZ, LUIS (DC)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:MARQUEZ
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 1:500 ROSITA AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCLIFFE
Mailing Address - State:CO
Mailing Address - Zip Code:81252
Mailing Address - Country:US
Mailing Address - Phone:719-783-2802
Mailing Address - Fax:719-783-2802
Practice Address - Street 1:500 ROSITA AVE
Practice Address - Street 2:
Practice Address - City:WESTCLIFFE
Practice Address - State:CO
Practice Address - Zip Code:81252
Practice Address - Country:US
Practice Address - Phone:719-783-2802
Practice Address - Fax:719-783-2802
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor