Provider Demographics
NPI:1154535011
Name:MARMO SPINE & REHAB, LTD
Entity type:Organization
Organization Name:MARMO SPINE & REHAB, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARMO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-469-9270
Mailing Address - Street 1:301 N. WHITE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:815-469-9270
Mailing Address - Fax:815-469-9544
Practice Address - Street 1:301 N WHITE ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1456
Practice Address - Country:US
Practice Address - Phone:815-469-9270
Practice Address - Fax:815-469-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty