Provider Demographics
NPI:1073639050
Name:MARONE FAMILY CHIROPRACTIC PA
Entity Type:Organization
Organization Name:MARONE FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-963-9304
Mailing Address - Street 1:647 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3235
Mailing Address - Country:US
Mailing Address - Phone:864-963-9304
Mailing Address - Fax:864-967-3810
Practice Address - Street 1:647 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3235
Practice Address - Country:US
Practice Address - Phone:864-963-9304
Practice Address - Fax:864-967-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1366526204OtherNPI
SCT258530281Medicare ID - Type Unspecified