Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 12566 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 12566 | TX |
NPI | 1295155620 |
---|---|
Provider Name | Mrs. Cassidie Ann Marzluff |
First Address | Rockwall, TX 75087-8746 |
Second Address | Rockwall, TX 75087-8746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2014 |
Last Update Date | 27/09/2015 |