Individual
MARLON MINOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RSA, CSA
Contact information
Practice address
112 BOEYKENS PL STE 2A, NORMAL, IL 61761-2152
(309) 846-4716
Mailing address
112 BOEYKENS PL STE 2A, NORMAL, IL 61761-2152
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
238.000282
IL
Other
Enumeration date
01/04/2011
Last updated
09/21/2011
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