Provider Demographics
NPI:1427083955
Name:MARINO, JOHN K (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:MARINO
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 1:102 PROGRESS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2516
Mailing Address - Country:US
Mailing Address - Phone:215-345-8141
Mailing Address - Fax:215-345-8173
Practice Address - Street 1:102 PROGRESS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2516
Practice Address - Country:US
Practice Address - Phone:215-345-8141
Practice Address - Fax:215-345-8173
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002942L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T30349Medicare UPIN
425316Medicare ID - Type Unspecified