Provider Demographics
NPI:1831113943
Name:DARDON, MARCO ANTONIO JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ANTONIO
Last Name:DARDON
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 S PASADENA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1838
Mailing Address - Country:US
Mailing Address - Phone:626-578-6322
Mailing Address - Fax:626-578-0148
Practice Address - Street 1:444 S PASADENA AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1838
Practice Address - Country:US
Practice Address - Phone:626-578-6322
Practice Address - Fax:626-578-0148
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22986OtherCHIROPRACTIC LICENSE #
CADC22986Medicare ID - Type Unspecified
CADC22986OtherCHIROPRACTIC LICENSE #