Provider Demographics
NPI:1194767293
Name:MARINI, STEPHEN C (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:MARINI
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 1:144 E DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2150
Mailing Address - Country:US
Mailing Address - Phone:610-337-3555
Mailing Address - Fax:
Practice Address - Street 1:144 E DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2150
Practice Address - Country:US
Practice Address - Phone:610-337-3555
Practice Address - Fax:610-337-8235
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003760-L111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0541982Medicaid
PA0541982Medicaid