Provider Demographics
NPI:1538237102
Name:DEMARCO, DEBRA (DC)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3371 LAWRENCEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-4719
Mailing Address - Country:US
Mailing Address - Phone:609-688-0104
Mailing Address - Fax:
Practice Address - Street 1:15 EAST RAILROAD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831
Practice Address - Country:US
Practice Address - Phone:732-521-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ02396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ520261Medicare PIN