Basic Information
| Provider Information | |||||||||
| NPI: | 1215959499 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSH | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 BEECHWOOD RD | ||||||||
| Address2: | |||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021843711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178164460 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 526 GALLIVAN BLVD | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER CENTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021245401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172821200 | ||||||||
| FaxNumber: | 6172829988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 2867 | MA | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | Y37116 | 01 | MA | BCBSMA | OTHER |