Provider Demographics
NPI:1033206727
Name:MARCKS, KRIS
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:MARCKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:VOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 43RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:815 TOWER PARK DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-9027
Practice Address - Country:US
Practice Address - Phone:319-233-6995
Practice Address - Fax:319-233-7083
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03011OtherTAXONOMY