=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073639050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARONE FAMILY CHIROPRACTIC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 04/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 647 SE MAIN ST
-----------------------------------------------------
City | SIMPSONVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29681-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-963-9304
-----------------------------------------------------
Fax | 864-967-3810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 647 SE MAIN ST
-----------------------------------------------------
City | SIMPSONVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29681-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-963-9304
-----------------------------------------------------
Fax | 864-967-3810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN G. MARONE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 864-963-9304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1737
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------