Provider Demographics
NPI:1427019496
Name:DIROMA, MARK PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:PAUL
Last Name:DIROMA
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 1:1899 N CONGRESS AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8215
Mailing Address - Country:US
Mailing Address - Phone:561-731-3361
Mailing Address - Fax:561-731-3374
Practice Address - Street 1:1899 N CONGRESS AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8215
Practice Address - Country:US
Practice Address - Phone:561-731-3361
Practice Address - Fax:561-731-3374
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006236111N00000X
NYX006058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380812200Medicaid
FL22718OtherBLUE CROSS/BLUE SHIELD
FL650960412OtherTAX ID NUMBER
FL380812200Medicaid