Provider Demographics
NPI:1992896963
Name:DEMARINO, JAMES JOHN (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOHN
Last Name:DEMARINO
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 1:2505 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19148
Mailing Address - Country:US
Mailing Address - Phone:215-551-3340
Mailing Address - Fax:215-551-3320
Practice Address - Street 1:2505 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19148
Practice Address - Country:US
Practice Address - Phone:215-551-3340
Practice Address - Fax:215-551-3320
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006292L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01568036Medicaid
PA0777239000OtherBCBS
PA804150Medicare PIN
PA0777239000OtherBCBS