Provider Demographics
NPI:1386646933
Name:CASALINO, MARK D (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:CASALINO
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 1:10255 N 35TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1361
Mailing Address - Country:US
Mailing Address - Phone:602-993-9933
Mailing Address - Fax:602-942-5032
Practice Address - Street 1:10255 N 35TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1361
Practice Address - Country:US
Practice Address - Phone:602-993-9933
Practice Address - Fax:602-942-5032
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ4317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0232670OtherBC/BS
AZ1Z3019OtherHEALTHNET
AZZ860589094Medicare PIN
AZAZ0232670OtherBC/BS