Provider Demographics
NPI:1194846071
Name:MARZILLI, ROBERT B JR (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:MARZILLI
Suffix:JR
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 1:1395 ATWOOD AVE
Mailing Address - Street 2:SUITE 108A
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-4929
Mailing Address - Country:US
Mailing Address - Phone:401-270-9595
Mailing Address - Fax:401-383-5155
Practice Address - Street 1:1395 ATWOOD AVE
Practice Address - Street 2:SUITE 108A
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4929
Practice Address - Country:US
Practice Address - Phone:401-270-9595
Practice Address - Fax:401-383-5155
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU74122Medicare UPIN