Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC010301 | PA |
N | 111NR0400X | Rehabilitation Chiropractor | AJ010100 | PA |
NPI | 1114230380 |
---|---|
Provider Name | Dr. Nicholas Stephen Marini |
First Address | King Of Prussia, PA 19406-2150 |
Second Address | King Of Prussia, PA 19406-2150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2010 |
Last Update Date | 16/07/2010 |