Provider Demographics
NPI:1902091697
Name:TODD L DEMARCO DC PA
Entity Type:Organization
Organization Name:TODD L DEMARCO DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-697-0006
Mailing Address - Street 1:1079 W SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:MINOTOLA
Mailing Address - State:NJ
Mailing Address - Zip Code:08341-1032
Mailing Address - Country:US
Mailing Address - Phone:856-697-0006
Mailing Address - Fax:856-697-9209
Practice Address - Street 1:1079 W SUMMER AVE
Practice Address - Street 2:
Practice Address - City:MINOTOLA
Practice Address - State:NJ
Practice Address - Zip Code:08341-1032
Practice Address - Country:US
Practice Address - Phone:856-697-0006
Practice Address - Fax:856-697-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5883495OtherAETNA
NJ8679207Medicaid
NJ741433OtherAETNA
NJ8679207Medicaid