Provider Demographics
NPI:1326093857
Name:TACZANOWSKI, MARC S (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:S
Last Name:TACZANOWSKI
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 1:631 LAKE AVENUE SUITE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780
Mailing Address - Country:US
Mailing Address - Phone:631-584-8783
Mailing Address - Fax:631-584-8784
Practice Address - Street 1:631 LAKE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1961
Practice Address - Country:US
Practice Address - Phone:631-584-8783
Practice Address - Fax:631-584-8784
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008229-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7E693Medicare ID - Type Unspecified