Provider Demographics
NPI:1295813368
Name:MARINO, JOSEPH JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:MARINO
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 1:635 W WATER STREET
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2409
Mailing Address - Country:US
Mailing Address - Phone:607-734-4333
Mailing Address - Fax:607-734-0658
Practice Address - Street 1:635 W WATER STREET
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2409
Practice Address - Country:US
Practice Address - Phone:607-734-4333
Practice Address - Fax:607-734-0658
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004170 1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY397820Medicare ID - Type Unspecified
NYT26630Medicare UPIN