Provider Demographics
NPI:1124390737
Name:MARRACCINI CHIROPRACTIC LIFE CENTER P.C.
Entity Type:Organization
Organization Name:MARRACCINI CHIROPRACTIC LIFE CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MARRACCINI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:412-531-1715
Mailing Address - Street 1:17 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3243
Mailing Address - Country:US
Mailing Address - Phone:412-531-1715
Mailing Address - Fax:412-531-6180
Practice Address - Street 1:17 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3243
Practice Address - Country:US
Practice Address - Phone:412-531-1715
Practice Address - Fax:412-531-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001872L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023544OtherBLUE CROSS BLUE SHEILD
PA70071Medicaid
PA023544OtherBLUE CROSS BLUE SHEILD
PA70071Medicaid