Provider Demographics
NPI:1588683627
Name:SANTILLO, MARC CHRISTOPHER (DC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:CHRISTOPHER
Last Name:SANTILLO
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30237-0069
Mailing Address - Country:US
Mailing Address - Phone:770-961-5577
Mailing Address - Fax:770-961-1407
Practice Address - Street 1:750 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3002
Practice Address - Country:US
Practice Address - Phone:770-961-5577
Practice Address - Fax:770-961-1407
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00219466OtherRAILROAD MEDICARE
GA35ZCFVTMedicare ID - Type Unspecified
GAU78768Medicare UPIN
GAGRP1288Medicare ID - Type UnspecifiedGROUP NUMBER