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General NPI Number Information
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NPI Number | 1972755809
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Entity Type | Individual
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Provider Name | JUSTIN MARIANO C.C.
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Gender | Male
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | LOT 147 CHALAN PALE ARNOLD ROAD GUALO RAI
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City | SAIPAN
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State | MP
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Zip | 96950
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Country | UM
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Telephone | 670-233-6325
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Fax | 670-235-4746
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Provider Business Mailing Address
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Address Line | PMB 1367 PO BOX 100003
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City | SAIPAN
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State | MP
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Zip | 96950
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Country | UM
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Telephone | 670-483-6325
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Fax | 670-235-4746
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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 | CHIR008340
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License Number State | GA
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