Provider Demographics
NPI:1982365185
Name:MARTUSCIELLO, MARCO ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ANTHONY
Last Name:MARTUSCIELLO
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 1:7830 LAWERENCE AVE.
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706
Mailing Address - Country:US
Mailing Address - Phone:708-751-8000
Mailing Address - Fax:708-457-1333
Practice Address - Street 1:7830 LAWERENCE AVE.
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-6048
Practice Address - Country:US
Practice Address - Phone:708-751-8000
Practice Address - Fax:708-457-1333
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor