MEDICARE: MARSHALL FAMILY CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	10290	MO

General Provider Information

NPI Number	:	1255605424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	7807 BAYMEADOWS RD E STE 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7807 BAYMEADOWS RD E STE 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9666
Country	:	US
Telephone Number	:	314-620-5267
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACOB MARSHALL
Credential	:	D.C.
Telephone Number	:	314-620-5267

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	03/05/2012

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