Provider Demographics
NPI:1003996943
Name:MARCHESANI, NICHOLAS R (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
Last Name:MARCHESANI
Suffix:
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 1:460 MYLAN PARK LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-2281
Mailing Address - Country:US
Mailing Address - Phone:304-983-7766
Mailing Address - Fax:304-983-7768
Practice Address - Street 1:460 MYLAN PARK LN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2281
Practice Address - Country:US
Practice Address - Phone:304-983-7766
Practice Address - Fax:304-983-7768
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4175743Medicare PIN