MEDICARE: MARSH PC DBA SPCC MT LAUREL

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	111N00000X	Chiropractor	2216	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51544181	OTHER	AL	BC/BS OF ALABAMA
2	51545360	OTHER	AL	BC/BS OF ALABAMA

General Provider Information

NPI Number	:	1548435399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSH PC DBA SPCC MT LAUREL

Provider Business Mailing Address
First Line	:	50 MANNING PL
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-1809
Country	:	US
Telephone Number	:	205-437-8837
Fax Number	:	205-437-3705

Provider Business Practice Location Address
First Line	:	50 MANNING PL
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-1809
Country	:	US
Telephone Number	:	205-437-8837
Fax Number	:	205-437-3705

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CYNDYE BIETIGHOFER
Credential	:
Telephone Number	:	205-437-8837

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	05/21/2008

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Directions to “MARSH PC DBA SPCC MT LAUREL ” Practice Location

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