Provider Demographics
NPI:1770561490
Name:MARINIELLO, SHANNON (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:MARINIELLO
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 1:517 RIVER DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-3270
Mailing Address - Country:US
Mailing Address - Phone:973-955-0755
Mailing Address - Fax:973-955-0753
Practice Address - Street 1:517 RIVER DR STE 2A
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-3270
Practice Address - Country:US
Practice Address - Phone:973-955-0755
Practice Address - Fax:973-955-0753
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00505700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1996718OtherUNITED HEALTHCARE
NJ31356OtherMASTERCARE
NJ5899591OtherGHI
NJ5936399004OtherCIGNA
NJX2D241OtherEMPIRE
NJ1047999OtherAETNA HMO
NJ050005057NJ01OtherANTHEM HEALTH
NJ0798375000OtherAMERIHEALTH
NJ96301OtherAMERIGROUP
NJ1126013OtherHORIZON NJ HEALTH
NJ5362694OtherAETNA
NJ5362694OtherAETNA PPO
NJ7722702Medicaid
NJ24878OtherUNIVERSITY HEALTH PLANS
NJP2084184OtherOXFORD
NJU72703Medicare UPIN
NJ021312Medicare ID - Type Unspecified