Provider Demographics
NPI:1700993763
Name:MARUSZEWSKI, TINA SY (DC)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:SY
Last Name:MARUSZEWSKI
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 1:89 W SOUTH BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1611
Mailing Address - Country:US
Mailing Address - Phone:248-289-6506
Mailing Address - Fax:248-289-6516
Practice Address - Street 1:89 W SOUTH BLVD
Practice Address - Street 2:STE 400
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1611
Practice Address - Country:US
Practice Address - Phone:248-289-6506
Practice Address - Fax:248-289-6516
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITM008126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H25864OtherBC GRP
MI950H210500OtherBCBSM PROVIDER NUMBER
MI950H210500OtherBCBSM PROVIDER NUMBER