Provider Demographics
NPI:1104659358
Name:CONSTANTINO, MARC (DC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:CONSTANTINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 S MYRTLE AVE UNIT 427
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-8620
Mailing Address - Country:US
Mailing Address - Phone:818-321-2802
Mailing Address - Fax:
Practice Address - Street 1:3607 W MAGNOLIA BLVD STE C
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2962
Practice Address - Country:US
Practice Address - Phone:747-245-5421
Practice Address - Fax:747-245-6095
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor