Provider Demographics
NPI:1922164334
Name:MARSILIO, MARIO JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:MARSILIO
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 1:3580 ALOMA AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4011
Mailing Address - Country:US
Mailing Address - Phone:407-657-6441
Mailing Address - Fax:321-214-4117
Practice Address - Street 1:3580 ALOMA AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4011
Practice Address - Country:US
Practice Address - Phone:407-657-6441
Practice Address - Fax:321-214-4117
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10748024OtherCAQH
FL628333OtherACN GROUP
FL70523Medicare ID - Type Unspecified