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General NPI Number Information
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NPI Number | 1053763698
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Entity Type | Individual
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Provider Name | JOHN D MARINO L.A.C
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Gender | Male
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 6 S BROAD ST
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City | LITITZ
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State | PA
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Zip | 17543-1402
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Country | US
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Telephone | 717-454-6762
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Fax | 773-496-8835
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Provider Business Mailing Address
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Address Line | 683 GOOSE NECK DR
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City | LITITZ
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State | PA
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Zip | 17543-8368
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Country | US
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Telephone | 312-505-1618
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Fax | 773-496-8835
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198001292
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MSG013782
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AK001302
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License Number State | PA
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