MEDICARE: DR. STACI MARAZONI PACIOREK D.C.

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	111NX0800X	Orthopedic Chiropractor	19528	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC019528	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1740358720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACI MARAZONI PACIOREK D.C.

Provider Business Mailing Address
First Line	:	12840 RIVERSIDE DR
Second Line	:	SUITE 201
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3327
Country	:	US
Telephone Number	:	818-905-3313
Fax Number	:

Provider Business Practice Location Address
First Line	:	12840 RIVERSIDE DR
Second Line	:	SUITE 201
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3327
Country	:	US
Telephone Number	:	818-905-3313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	06/15/2017

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