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General NPI Number Information
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NPI Number | 1972783934
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Entity Type | Organization
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Legal Business Name | PENNSAUKEN SPINE AND REHAB
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 4307 WESTFIELD AVE
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City | PENNSAUKEN
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State | NJ
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Zip | 08110-3023
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Country | US
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Telephone | 856-488-0222
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Fax | 856-488-0233
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Provider Business Mailing Address
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Address Line | 4307 WESTFIELD AVE
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City | PENNSAUKEN
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State | NJ
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Zip | 08110-3023
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Country | US
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Telephone | 856-488-0222
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Fax | 856-488-0233
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOMINIC MARIANI
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Credential | D.C.
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Telephone | 856-488-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 38MC00349500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 38MC00319800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 38MC00387000
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License Number State | NJ
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