Provider Demographics
NPI:1710156724
Name:ROTELLA, MARYJOYCE (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:MARYJOYCE
Middle Name:
Last Name:ROTELLA
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15891 KRUHM RD
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1411
Mailing Address - Country:US
Mailing Address - Phone:301-421-4248
Mailing Address - Fax:
Practice Address - Street 1:15891 KRUHM RD
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1411
Practice Address - Country:US
Practice Address - Phone:301-421-4248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-23
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA009359111N00000X
PAOM000042171100000X
MDS03750111N00000X
MDU02035171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist