Healthcare Provider Details

I. General information

NPI: 1366685240
Provider Name (Legal Business Name): MARLA ROBIN GEBAIDE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 DEMOCRACY LN SUITE 110
FAIRFAX VA
22030-2545
US

IV. Provider business mailing address

1645 DUNLAWTON AVE APT 2414
PORT ORANGE FL
32127-7967
US

V. Phone/Fax

Practice location:
  • Phone: 703-293-2939
  • Fax:
Mailing address:
  • Phone: 786-271-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556704
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: