Provider Demographics
NPI:1073513842
Name:PASSIFIUME, MAUREEN L (DC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:L
Last Name:PASSIFIUME
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 1:5577 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3914
Mailing Address - Country:US
Mailing Address - Phone:614-436-3870
Mailing Address - Fax:614-436-0953
Practice Address - Street 1:5577 N HIGH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3914
Practice Address - Country:US
Practice Address - Phone:614-436-3870
Practice Address - Fax:614-436-0953
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHU83062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4038961OtherMEDICARE-INDIVIDUAL
OHPA2205563Medicaid
U83062Medicare UPIN