Provider Demographics
NPI:1750824835
Name:EARLINE MARCHELLO
Entity Type:Organization
Organization Name:EARLINE MARCHELLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:EARLINE
Authorized Official - Last Name:MARCHELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:358-238-9806
Mailing Address - Street 1:PO BOX 13825
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84412-3825
Mailing Address - Country:US
Mailing Address - Phone:385-238-9806
Mailing Address - Fax:
Practice Address - Street 1:1190 E 5425 S
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4548
Practice Address - Country:US
Practice Address - Phone:385-238-9806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT352031 1201261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center