Healthcare Provider Details

I. General information

NPI: 1316351257
Provider Name (Legal Business Name): ASHLEY NICOLE MARCHEK VICEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 XENIA AVE
YELLOW SPRINGS OH
45387-1632
US

IV. Provider business mailing address

419 GREENMOUNT BLVD
DAYTON OH
45419-3231
US

V. Phone/Fax

Practice location:
  • Phone: 937-709-3786
  • Fax:
Mailing address:
  • Phone: 937-371-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number4431
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: