Provider Demographics
NPI:1053763698
Name:MARINO, JOHN D (LAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:MARINO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:683 GOOSE NECK DR
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8368
Mailing Address - Country:US
Mailing Address - Phone:312-505-1618
Mailing Address - Fax:773-496-8835
Practice Address - Street 1:6 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1402
Practice Address - Country:US
Practice Address - Phone:717-454-6762
Practice Address - Fax:773-496-8835
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL198001292171100000X
PAMSG013782225700000X
PAAK001302171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist