Provider Demographics
NPI:1346464757
Name:VENEZIALI, MARYLOU (DC)
Entity Type:Individual
Prefix:DR
First Name:MARYLOU
Middle Name:
Last Name:VENEZIALI
Suffix:
Gender:F
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:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-0626
Mailing Address - Country:US
Mailing Address - Phone:845-928-6278
Mailing Address - Fax:845-928-6751
Practice Address - Street 1:287 ROUTE 32
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-0626
Practice Address - Country:US
Practice Address - Phone:845-928-6278
Practice Address - Fax:845-928-6751
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003698-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor