Provider Demographics
NPI:1245408384
Name:MARIENTHAL CHIROPRACTIC HEALTH & WELLNESS CENTER PA
Entity Type:Organization
Organization Name:MARIENTHAL CHIROPRACTIC HEALTH & WELLNESS CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MARIENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-421-2644
Mailing Address - Street 1:36 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3504
Mailing Address - Country:US
Mailing Address - Phone:954-421-2644
Mailing Address - Fax:954-428-7502
Practice Address - Street 1:36 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3504
Practice Address - Country:US
Practice Address - Phone:954-421-2644
Practice Address - Fax:954-428-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty