Provider Demographics
NPI:1790878999
Name:LOMAN, MARYELLA K (DC)
Entity Type:Individual
Prefix:DR
First Name:MARYELLA
Middle Name:K
Last Name:LOMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARYELLA
Other - Middle Name:K
Other - Last Name:GRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2515 NORTHBROOKE PLAZA DR
Mailing Address - Street 2:102
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8088
Mailing Address - Country:US
Mailing Address - Phone:239-597-6099
Mailing Address - Fax:239-597-6987
Practice Address - Street 1:2515 NORTHBROOKE PLAZA DR
Practice Address - Street 2:102
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8088
Practice Address - Country:US
Practice Address - Phone:239-597-6099
Practice Address - Fax:239-597-6987
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29120Medicare UPIN
FL22742ZMedicare ID - Type Unspecified