Provider Demographics
NPI:1790963569
Name:MARC DEODATO LLC
Entity Type:Organization
Organization Name:MARC DEODATO LLC
Other - Org Name:BRYN MAWR INTEGRATED HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SABERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-527-8127
Mailing Address - Street 1:945 E HAVERFORD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3814
Mailing Address - Country:US
Mailing Address - Phone:610-527-8127
Mailing Address - Fax:610-527-3905
Practice Address - Street 1:945 E HAVERFORD RD
Practice Address - Street 2:SUITE A
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3814
Practice Address - Country:US
Practice Address - Phone:610-527-8127
Practice Address - Fax:610-527-3905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SABERS CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-04
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty