Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH9058 | FL |
N | 111NS0005X | Chiropractic Sports Physician | 4334 | NC |
NPI | 1265431761 |
---|---|
Provider Name | Dr. Mark Creston Marien |
First Address | Cornelius, NC 28031 |
Second Address | Cornelius, NC 28031-8650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 20/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70040 | BLUE CROSS (01) | FL |
V06257 | (02) | FL |