Healthcare Provider Details

I. General information

NPI: 1609870146
Provider Name (Legal Business Name): JOHN L MARSH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 BANDERA RD STE 302
SAN ANTONIO TX
78250-3224
US

IV. Provider business mailing address

8910 BANDERA RD STE 302
SAN ANTONIO TX
78250-3224
US

V. Phone/Fax

Practice location:
  • Phone: 210-684-6932
  • Fax: 210-521-1995
Mailing address:
  • Phone: 210-684-6932
  • Fax: 210-521-1995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9280
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: