Provider Demographics
NPI:1023234127
Name:MARINO, JOHN A (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MARINO
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 1:535 GALA DRIVE
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317
Mailing Address - Country:US
Mailing Address - Phone:724-379-6160
Mailing Address - Fax:724-379-7203
Practice Address - Street 1:1112 FELLS CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012
Practice Address - Country:US
Practice Address - Phone:724-379-6160
Practice Address - Fax:724-379-7203
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC5946L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE33571OtherAMERIHEALTH
PAMA533571OtherHIGHMARK BLUES SHIELD
PAE33571OtherAMERIHEALTH
PAMA533571OtherHIGHMARK BLUES SHIELD