Provider Demographics
NPI:1821120437
Name:MARCO CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:MARCO CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-767-0177
Mailing Address - Street 1:8246 SUNLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3301
Mailing Address - Country:US
Mailing Address - Phone:818-767-0177
Mailing Address - Fax:
Practice Address - Street 1:8246 SUNLAND BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3301
Practice Address - Country:US
Practice Address - Phone:818-767-0177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC7764Medicare ID - Type Unspecified