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General NPI Number Information
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NPI Number | 1871115741
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Entity Type | Individual
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Provider Name | CHAD R MARSHALL DO
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Gender | Male
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 530 NE GLEN OAK AVE
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City | PEORIA
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State | IL
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Zip | 61637-0001
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Country | US
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Telephone | 309-624-8818
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Fax | 309-624-8820
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Provider Business Mailing Address
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Address Line | 526 COTTONWOOD CIR
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City | EAST PEORIA
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State | IL
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Zip | 61611-4008
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Country | US
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Telephone | 325-829-9688
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036165717
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 94-10214
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License Number State | KS
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