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General NPI Number Information
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NPI Number | 1780853119
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Entity Type | Organization
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Legal Business Name | MARIO FUCINARI DC LLC
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 3350 N WATER ST SUITE A
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City | DECATUR
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State | IL
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Zip | 62526-2353
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Country | US
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Telephone | 217-877-2404
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Fax | 217-877-2522
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Provider Business Mailing Address
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Address Line | 3350 N WATER ST SUITE A
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City | DECATUR
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State | IL
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Zip | 62526-2353
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Country | US
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Telephone | 217-877-2404
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Fax | 217-877-2522
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIO PAUL FUCINARI
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Credential | DC
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Telephone | 21787724074
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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 | 038-005800
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License Number State | IL
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