Healthcare Provider Details

I. General information

NPI: 1871115741
Provider Name (Legal Business Name): CHAD R MARSHALL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

526 COTTONWOOD CIR
EAST PEORIA IL
61611-4008
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-8818
  • Fax: 309-624-8820
Mailing address:
  • Phone: 325-829-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036165717
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-10214
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: