Provider Demographics
NPI:1225107600
Name:MARTUSCIELLO, ANNA MARIA (DC)
Entity Type:Individual
Prefix:DR
First Name:ANNA MARIA
Middle Name:
Last Name:MARTUSCIELLO
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 1:7702 S CASS
Mailing Address - Street 2:STE 220
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561
Mailing Address - Country:US
Mailing Address - Phone:630-493-9399
Mailing Address - Fax:630-493-0950
Practice Address - Street 1:7702 S CASS AVE
Practice Address - Street 2:STE220
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5093
Practice Address - Country:US
Practice Address - Phone:630-493-9399
Practice Address - Fax:630-493-0950
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT38765Medicare UPIN
IL559450Medicare ID - Type Unspecified