Provider Demographics
NPI:1659476661
Name:ARCIOM, MARY JO (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:ARCIOM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-677-1212
Mailing Address - Fax:386-872-7831
Practice Address - Street 1:244 9TH STREET
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-677-1212
Practice Address - Fax:386-872-7831
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5752111N00000X
FLCH5752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05165300Medicaid
22208OtherBC/BS
FL05165300Medicaid