Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | WV716 | WV |
NPI | 1003996943 |
---|---|
Provider Name | Nicholas R Marchesani |
First Address | Morgantown, WV 26501-2281 |
Second Address | Morgantown, WV 26501-2281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 10/05/2011 |