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General NPI Number Information
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NPI Number | 1437318185
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Entity Type | Individual
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Provider Name | TANYA MARRACCINI BROADED D.C.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2008
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Last Update Date | 06/07/2008
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Provider Practice Location Address
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Address Line | 720 W MAXWELL ST
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City | CHICAGO
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State | IL
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Zip | 60607-5017
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Country | US
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Telephone | 312-733-6940
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Fax |
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Provider Business Mailing Address
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Address Line | 1530 S STATE ST UNIT 510
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City | CHICAGO
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State | IL
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Zip | 60605-2964
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Country | US
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Telephone | 312-399-9855
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.011107
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License Number State | IL
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