Provider Demographics
NPI:1154500924
Name:MARANDINO SCHARGEN CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:MARANDINO SCHARGEN CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARANDINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-673-2424
Mailing Address - Street 1:301 KENILWORTH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4545
Mailing Address - Country:US
Mailing Address - Phone:386-673-2424
Mailing Address - Fax:386-673-8222
Practice Address - Street 1:301 KENILWORTH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4545
Practice Address - Country:US
Practice Address - Phone:386-673-2424
Practice Address - Fax:386-673-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5840Medicare PIN