Provider Demographics
NPI:1750336988
Name:PICCHIERRI, MARC A (DC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:PICCHIERRI
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 1:205 ROBIN RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1449
Mailing Address - Country:US
Mailing Address - Phone:201-225-1511
Mailing Address - Fax:201-225-9731
Practice Address - Street 1:205 ROBIN RD
Practice Address - Street 2:SUITE 118
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1449
Practice Address - Country:US
Practice Address - Phone:201-225-1511
Practice Address - Fax:201-225-9731
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00183600111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ065311OtherMEDICARE PTAN
NJ143403Q98Medicare PIN
NJ065311OtherMEDICARE PTAN