1972755809 NPI number — DR. JUSTIN MARIANO C.C.

Table of content: DR. JUSTIN MARIANO C.C. (NPI 1972755809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972755809 NPI number — DR. JUSTIN MARIANO C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARIANO
Provider First Name:
JUSTIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
C.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972755809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 1367 PO BOX 100003
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAIPAN
Provider Business Mailing Address State Name:
MP
Provider Business Mailing Address Postal Code:
96950
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
670-483-6325
Provider Business Mailing Address Fax Number:
670-235-4746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LOT 147 CHALAN PALE ARNOLD ROAD
Provider Second Line Business Practice Location Address:
GUALO RAI
Provider Business Practice Location Address City Name:
SAIPAN
Provider Business Practice Location Address State Name:
MP
Provider Business Practice Location Address Postal Code:
96950
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
670-233-6325
Provider Business Practice Location Address Fax Number:
670-235-4746
Provider Enumeration Date:
10/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIR008340 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0014 . This is a "SAIPAN CHIROPRACTIC LICENCE" identifier , issued by the state of ( MP ) . This identifiers is of the category "OTHER".




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