Provider Demographics
NPI:1396726188
Name:GUARINO, MARK GERARD (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GERARD
Last Name:GUARINO
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 1:10148 W BROAD ST
Mailing Address - Street 2:STE 101
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6760
Mailing Address - Country:US
Mailing Address - Phone:804-747-7474
Mailing Address - Fax:804-965-9360
Practice Address - Street 1:10148 W BROAD ST
Practice Address - Street 2:STE 101
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6760
Practice Address - Country:US
Practice Address - Phone:804-747-7474
Practice Address - Fax:804-965-9360
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
170425OtherSOUTHERN HEALTH
460541OtherACN
0827590OtherCIGNA
2125679OtherAETNA
4400136OtherUNITED HEALTH CARE
054234OtherANTHEM
1456026OtherBLUE CROSS HIGH MARK
1456026OtherBLUE CROSS HIGH MARK