Provider Demographics
NPI:1104906171
Name:MARCO, RAUL M (DC)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:M
Last Name:MARCO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8246 SUNLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3301
Mailing Address - Country:US
Mailing Address - Phone:818-767-0177
Mailing Address - Fax:818-768-6397
Practice Address - Street 1:8246 SUNLAND BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3301
Practice Address - Country:US
Practice Address - Phone:818-767-0177
Practice Address - Fax:818-768-6397
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12466111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12466Medicare PIN