Provider Demographics
NPI:1972755809
Name:MARIANO, JUSTIN (CC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:MARIANO
Suffix:
Gender:M
Credentials:CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 1367 PO BOX 100003
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:UM
Mailing Address - Phone:670-483-6325
Mailing Address - Fax:670-235-4746
Practice Address - Street 1:LOT 147 CHALAN PALE ARNOLD ROAD
Practice Address - Street 2:GUALO RAI
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:UM
Practice Address - Phone:670-233-6325
Practice Address - Fax:670-235-4746
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP0014OtherSAIPAN CHIROPRACTIC LICENCE