Provider Demographics
NPI:1366685240
Name:GEBAIDE, MARLA ROBIN (DC)
Entity type:Individual
Prefix:DR
First Name:MARLA
Middle Name:ROBIN
Last Name:GEBAIDE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 DUNLAWTON AVE
Mailing Address - Street 2:APT 2414
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-7967
Mailing Address - Country:US
Mailing Address - Phone:786-271-3311
Mailing Address - Fax:
Practice Address - Street 1:10301 DEMOCRACY LN
Practice Address - Street 2:SUITE 110
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2545
Practice Address - Country:US
Practice Address - Phone:703-293-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor