Healthcare Provider Details

I. General information

NPI: 1265547707
Provider Name (Legal Business Name): MARC DAQUILA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BENMONT AVE SUITE 23
BENNINGTON VT
05201-1873
US

IV. Provider business mailing address

160 BENMONT AVE SUITE 23
BENNINGTON VT
05201-1873
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-3455
  • Fax:
Mailing address:
  • Phone: 802-447-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1880
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: