Provider Demographics
NPI:1669695383
Name:MARCUS, A NALYN RUSSO (DC)
Entity type:Individual
Prefix:DR
First Name:A NALYN
Middle Name:RUSSO
Last Name:MARCUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NALYN
Other - Middle Name:RUSSO
Other - Last Name:MARCUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:820 EATON AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1832
Mailing Address - Country:US
Mailing Address - Phone:610-974-8900
Mailing Address - Fax:610-974-9344
Practice Address - Street 1:820 EATON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1832
Practice Address - Country:US
Practice Address - Phone:610-974-8900
Practice Address - Fax:610-974-9344
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004477L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02828900OtherCAPITAL BC
0473510000OtherINDEPENDENT BS
PA642920OtherBLUE SHIELD
PA642920Medicare ID - Type Unspecified