Provider Demographics
NPI:1306863972
Name:PAESE, MARCO ALBERTO (DC)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:ALBERTO
Last Name:PAESE
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 1:736 WOODLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5172
Mailing Address - Country:US
Mailing Address - Phone:248-933-8138
Mailing Address - Fax:
Practice Address - Street 1:1112 S LAPEER RD STE B
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3396
Practice Address - Country:US
Practice Address - Phone:810-245-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3508091Medicaid
MI3508091Medicaid