MEDICARE: MARLA M ST. JOHN D.C.

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	27 2754	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558365965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLA M ST. JOHN D.C.

Provider Business Mailing Address
First Line	:	1942 12TH ST
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-9542
Country	:	US
Telephone Number	:	541-386-1638
Fax Number	:	541-308-0614

Provider Business Practice Location Address
First Line	:	1942 12TH ST
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-9542
Country	:	US
Telephone Number	:	541-386-1638
Fax Number	:	541-308-0614

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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