Provider Demographics
NPI:1962560813
Name:PETRUNEY, MARILYNN ANN (DC)
Entity type:Individual
Prefix:
First Name:MARILYNN
Middle Name:ANN
Last Name:PETRUNEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 FAXON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3704
Mailing Address - Country:US
Mailing Address - Phone:570-326-1510
Mailing Address - Fax:
Practice Address - Street 1:818 FAXON PARKWAY
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3704
Practice Address - Country:US
Practice Address - Phone:570-326-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004965L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPE721937Medicare ID - Type Unspecified