Provider Demographics
NPI:1891854063
Name:FIRILLO, MARCUS J (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:J
Last Name:FIRILLO
Suffix:
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 1:5401 W ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3696
Mailing Address - Country:US
Mailing Address - Phone:303-232-2436
Mailing Address - Fax:303-234-1945
Practice Address - Street 1:5401 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3696
Practice Address - Country:US
Practice Address - Phone:303-232-2436
Practice Address - Fax:303-234-1945
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC28153Medicare PIN