Provider Demographics
NPI:1679620116
Name:MARINA, ROBERT III (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MARINA
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BEATTIES FORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-3732
Mailing Address - Country:US
Mailing Address - Phone:704-399-3794
Mailing Address - Fax:704-697-9812
Practice Address - Street 1:3000 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-3732
Practice Address - Country:US
Practice Address - Phone:704-399-3794
Practice Address - Fax:704-697-9812
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor