MEDICARE: DR. NATHAN MARSHALL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	34192	CA

General Provider Information

NPI Number	:	1093206799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN MARSHALL DC

Provider Business Mailing Address
First Line	:	5252 BALBOA AVE STE 901
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6917
Country	:	US
Telephone Number	:	858-560-5022
Fax Number	:

Provider Business Practice Location Address
First Line	:	5252 BALBOA AVE STE 901
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6917
Country	:	US
Telephone Number	:	858-560-5022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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