Provider Demographics
NPI:1689782955
Name:DIZON, MARCELINO ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCELINO
Middle Name:ANTHONY
Last Name:DIZON
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 1:1069 RINGWOOD AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:HASKELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07420-1408
Mailing Address - Country:US
Mailing Address - Phone:973-835-3400
Mailing Address - Fax:973-835-3411
Practice Address - Street 1:1069 RINGWOOD AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:HASKELL
Practice Address - State:NJ
Practice Address - Zip Code:07420-1408
Practice Address - Country:US
Practice Address - Phone:973-835-3400
Practice Address - Fax:973-835-3411
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00553400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor