Provider Demographics
NPI:1487981106
Name:MARANDO, TIMOTHY PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:MARANDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W DIVERSEY PKWY
Mailing Address - Street 2:SUITE 2W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1010
Mailing Address - Country:US
Mailing Address - Phone:773-348-0033
Mailing Address - Fax:773-348-0553
Practice Address - Street 1:1700 W DIVERSEY PKWY
Practice Address - Street 2:SUITE 2W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1010
Practice Address - Country:US
Practice Address - Phone:773-348-0033
Practice Address - Fax:773-348-0553
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor