MEDICARE: MARSHALL CHIROPRACTIC WELLNESS CENTER, INC.

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	DC27683	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1477697605	OTHER	CA	NPI

General Provider Information

NPI Number	:	1750667853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL CHIROPRACTIC WELLNESS CENTER, INC.

Provider Business Mailing Address
First Line	:	1055 N HARPER AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5906
Country	:	US
Telephone Number	:	323-848-6997
Fax Number	:	323-848-6998

Provider Business Practice Location Address
First Line	:	1055 N HARPER AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5906
Country	:	US
Telephone Number	:	323-848-6997
Fax Number	:	323-848-6998

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHELLE PATRICIA MARSHALL
Credential	:	D.C
Telephone Number	:	323-848-6997

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	11/02/2011

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Directions to “MARSHALL CHIROPRACTIC WELLNESS CENTER, INC. ” Practice Location

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