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General NPI Number Information
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NPI Number | 1376710574
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Entity Type | Organization
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Legal Business Name | TED E MARRIOTT, D.C., A PROFESSIONAL CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 06/05/2010
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Provider Practice Location Address
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Address Line | 600 S LAKE AVE SUITE 204
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City | PASADENA
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State | CA
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Zip | 91106-3955
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Country | US
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Telephone | 626-808-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 600 S LAKE AVE SUITE 204
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City | PASADENA
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State | CA
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Zip | 91106-3955
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Country | US
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Telephone | 626-808-1515
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TED E MARRIOTT
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Credential | D.C.
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Telephone | 626-808-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC21747
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License Number State | CA
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