Provider Demographics
NPI:1154330272
Name:MORAMARCO, MARC MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:MICHAEL
Last Name:MORAMARCO
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 1:20 CARTER LN
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-6071
Mailing Address - Country:US
Mailing Address - Phone:978-470-0680
Mailing Address - Fax:
Practice Address - Street 1:3 BALDWIN GREEN CMN
Practice Address - Street 2:SUITE 204
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1865
Practice Address - Country:US
Practice Address - Phone:781-938-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MATUFTSOther729503
MA352364OtherHARVARD PILGRIM
MAY35835OtherBLUE CROSS BLUE SHIELD
MA4404513OtherUNITED HEALTHCARE
MAT58407Medicare UPIN
MAY35825Medicare ID - Type Unspecified