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General NPI Number Information
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NPI Number | 1912988973
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Entity Type | Organization
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Legal Business Name | MARUCCI WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9370 SW 72ND ST SUITE A150
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City | MIAMI
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State | FL
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Zip | 33173-5431
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Country | US
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Telephone | 305-663-6681
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Fax |
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Provider Business Mailing Address
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Address Line | 9370 SW 72ND ST SUITE A150
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City | MIAMI
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State | FL
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Zip | 33173-5431
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Country | US
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Telephone | 305-663-6681
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON T MARUCCI
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Credential | D.C.
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Telephone | 305-663-6681
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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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