Healthcare Provider Details

I. General information

NPI: 1114697075
Provider Name (Legal Business Name): MARION ACCIDENT & INJURY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 E CENTER ST
MARION OH
43302-4244
US

IV. Provider business mailing address

128 SOUTHERN MANOR RD
VANCEBURG KY
41179-7511
US

V. Phone/Fax

Practice location:
  • Phone: 740-386-6580
  • Fax:
Mailing address:
  • Phone: 606-796-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DONNA CAUDILL
Title or Position: TREASURER
Credential:
Phone: 606-796-0385