Provider Demographics
NPI:1124198007
Name:MARIELLA CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MARIELLA CHIROPRACTIC INC
Other - Org Name:BODY STRUCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MARIELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-469-8062
Mailing Address - Street 1:1011 NORTH COLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038
Mailing Address - Country:US
Mailing Address - Phone:323-469-8062
Mailing Address - Fax:323-469-8064
Practice Address - Street 1:1011 NORTH COLE AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038
Practice Address - Country:US
Practice Address - Phone:323-469-8062
Practice Address - Fax:323-469-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty