Provider Demographics
NPI:1003101593
Name:MAREK, BRIAN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEE
Last Name:MAREK
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 1:2660 N HASKELL AVE
Mailing Address - Street 2:3158
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2918
Mailing Address - Country:US
Mailing Address - Phone:469-404-9116
Mailing Address - Fax:
Practice Address - Street 1:4801 S BUCKNER BLVD
Practice Address - Street 2:200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-2373
Practice Address - Country:US
Practice Address - Phone:214-381-7700
Practice Address - Fax:214-381-5510
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4738-012111N00000X
IL038011967111N00000X
TX12363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor