Provider Demographics
NPI:1922185446
Name:CANTU, MARIE C (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:C
Last Name:CANTU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:GREGORY
Other - Last Name:CANTU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:40 STILL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4108
Mailing Address - Country:US
Mailing Address - Phone:845-783-6868
Mailing Address - Fax:845-782-6601
Practice Address - Street 1:40 STILL RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4108
Practice Address - Country:US
Practice Address - Phone:845-783-6868
Practice Address - Fax:845-782-6601
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX23111Medicare ID - Type Unspecified