Provider Demographics
NPI:1689665168
Name:MARUCCI, JASON T (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:MARUCCI
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 1:755 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SOUTHBRIDGE WEST, BUILDING P UNIT 1
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4300
Mailing Address - Country:US
Mailing Address - Phone:330-286-3669
Mailing Address - Fax:
Practice Address - Street 1:755 BOARDMAN CANFIELD RD
Practice Address - Street 2:SOUTHBRIDGE WEST, BUILDING P UNIT 1
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4300
Practice Address - Country:US
Practice Address - Phone:330-286-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2794132Medicaid
FL381768700Medicaid
OH9375191OtherMEDICARE
OH2794132Medicaid
OH9375191OtherMEDICARE
OHU77658Medicare UPIN