Provider Demographics
NPI:1629159157
Name:MARIOTTI, J CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:CHRISTOPHER
Last Name:MARIOTTI
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 1:801 RYE BEACH ROAD
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-2068
Mailing Address - Country:US
Mailing Address - Phone:419-433-5432
Mailing Address - Fax:419-433-5105
Practice Address - Street 1:801 RYE BEACH ROAD
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-2068
Practice Address - Country:US
Practice Address - Phone:419-433-5432
Practice Address - Fax:419-433-5105
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0694897Medicaid
OH0694897Medicaid
OHMA0454993Medicare ID - Type Unspecified