Provider Demographics
NPI:1912272832
Name:CHIANESE, MARC TA (MS, DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:TA
Last Name:CHIANESE
Suffix:
Gender:M
Credentials:MS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 MASTERSON CT
Mailing Address - Street 2:#547
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1448
Mailing Address - Country:US
Mailing Address - Phone:609-577-4110
Mailing Address - Fax:
Practice Address - Street 1:547 MASTERSON CT
Practice Address - Street 2:#547
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1448
Practice Address - Country:US
Practice Address - Phone:609-577-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008892111N00000X
NJ38MC00711300111N00000X
PADC010742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor