Provider Demographics
NPI:1992760524
Name:CAGLE, MARV R (DC)
Entity type:Individual
Prefix:DR
First Name:MARV
Middle Name:R
Last Name:CAGLE
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 1:307 RUTHERFORD ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5309
Mailing Address - Country:US
Mailing Address - Phone:864-235-9766
Mailing Address - Fax:
Practice Address - Street 1:307 RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5309
Practice Address - Country:US
Practice Address - Phone:864-235-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC628111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT249170281Medicare PIN