Provider Demographics
NPI:1184841777
Name:MARANDINO, MARCIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:
Last Name:MARANDINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 KENILWORTH AVE STE A
Mailing Address - Street 2:
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 STE A
Practice Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88891AMedicare PIN
FLV00085Medicare UPIN