Provider Demographics
NPI:1538456223
Name:PEROSINO, MARIANA J (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:J
Last Name:PEROSINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:64 BARRINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4922
Mailing Address - Country:US
Mailing Address - Phone:770-427-7387
Mailing Address - Fax:770-426-1491
Practice Address - Street 1:950 COBB PKWY S STE 190
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6500
Practice Address - Country:US
Practice Address - Phone:770-427-7387
Practice Address - Fax:770-427-6149
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor