Provider Demographics
NPI:1639248800
Name:MARIANO, CIPRIANO FABIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CIPRIANO
Middle Name:FABIAN
Last Name:MARIANO
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 1:576 E VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5122
Mailing Address - Country:US
Mailing Address - Phone:732-928-5888
Mailing Address - Fax:732-928-1648
Practice Address - Street 1:576 E VETERANS HWY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5122
Practice Address - Country:US
Practice Address - Phone:732-928-5888
Practice Address - Fax:732-928-1648
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ443787Medicare ID - Type Unspecified