Provider Demographics
NPI:1639132210
Name:MARSILLO, ROBERT JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:MARSILLO
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 1:433 POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-3606
Mailing Address - Country:US
Mailing Address - Phone:203-656-2044
Mailing Address - Fax:203-656-2042
Practice Address - Street 1:484 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820
Practice Address - Country:US
Practice Address - Phone:203-656-2044
Practice Address - Fax:203-656-2042
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000634CT01OtherBC/BS
CTP463905OtherOXFORD
CT4334475OtherAETNA
CT4334475OtherAETNA
CT350000461Medicare ID - Type UnspecifiedMEDICARE