Provider Demographics
NPI:1548485790
Name:MARRANCA, MARYELLEN EVA (DC)
Entity type:Individual
Prefix:DR
First Name:MARYELLEN
Middle Name:EVA
Last Name:MARRANCA
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 1:106 JEAN ST
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1514
Mailing Address - Country:US
Mailing Address - Phone:570-654-5152
Mailing Address - Fax:570-654-5152
Practice Address - Street 1:1137 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:PA
Practice Address - Zip Code:18643-1944
Practice Address - Country:US
Practice Address - Phone:570-654-5152
Practice Address - Fax:570-654-5152
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-005509-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA425023OtherHEALTH AMERICA
PA804810OtherFIRST PRIORITY HEALTH
PA001494040 0001Medicaid
PA804810OtherFIRST PRIORITY HEALTH
PA001494040 0001Medicaid