Provider Demographics
NPI:1619175130
Name:MARINO, RONALD J (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:MARINO
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 1:22600 VENTURA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1431
Mailing Address - Country:US
Mailing Address - Phone:818-593-7099
Mailing Address - Fax:818-591-1007
Practice Address - Street 1:22600 VENTURA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1431
Practice Address - Country:US
Practice Address - Phone:818-593-7099
Practice Address - Fax:818-591-1007
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor