MEDICARE: MARINO CHIROPRACTIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11222	TX

General Provider Information

NPI Number	:	1467788661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARINO CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	17313 EL CAMINO REAL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2718
Country	:	US
Telephone Number	:	281-486-0221
Fax Number	:

Provider Business Practice Location Address
First Line	:	17313 EL CAMINO REAL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2718
Country	:	US
Telephone Number	:	281-486-0221
Fax Number	:

Authorized Official
Title or Position	:	DR
Name	:	DR. LEONARD MARINO
Credential	:	D.C
Telephone Number	:	281-486-0221

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	10/22/2009

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