Provider Demographics
NPI:1770806432
Name:MARMANILLO, DIEGO A (DC)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:A
Last Name:MARMANILLO
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 1:35 RED BARN RD
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-7457
Mailing Address - Country:US
Mailing Address - Phone:845-868-2314
Mailing Address - Fax:
Practice Address - Street 1:450 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2577
Practice Address - Country:US
Practice Address - Phone:845-344-0444
Practice Address - Fax:845-344-0456
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor