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General NPI Number Information
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NPI Number | 1689665168
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Entity Type | Individual
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Provider Name | JASON T MARUCCI D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 755 BOARDMAN CANFIELD RD SOUTHBRIDGE WEST, BUILDING P UNIT 1
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City | BOARDMAN
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State | OH
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Zip | 44512-4300
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Country | US
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Telephone | 330-286-3669
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Fax |
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Provider Business Mailing Address
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Address Line | 755 BOARDMAN CANFIELD RD SOUTHBRIDGE WEST, BUILDING P UNIT 1
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City | BOARDMAN
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State | OH
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Zip | 44512-4300
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Country | US
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Telephone | 330-286-3669
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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 | CH7589
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License Number State | FL
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