Provider Demographics
NPI:1235203951
Name:MARKO, RICHARD B (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:MARKO
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 1:2041 WILLISTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6078
Mailing Address - Country:US
Mailing Address - Phone:802-863-0334
Mailing Address - Fax:802-862-6604
Practice Address - Street 1:2041 WILLISTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6078
Practice Address - Country:US
Practice Address - Phone:802-863-0334
Practice Address - Fax:802-862-6604
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0000817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0892402-001OtherCIGNA
VT035-4311OtherBCBS
VTVT9253Medicaid
VTMA9253Medicare ID - Type Unspecified
VTVT9253Medicaid