Provider Demographics
NPI:1164664819
Name:VESELACK, MARILYN S (DA)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:S
Last Name:VESELACK
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 NORTH 1ST STREET
Mailing Address - Street 2:SUITE #6
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7471
Mailing Address - Country:US
Mailing Address - Phone:970-255-8037
Mailing Address - Fax:970-424-5013
Practice Address - Street 1:138 NORTH 1ST STREET
Practice Address - Street 2:SUITE #6
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7471
Practice Address - Country:US
Practice Address - Phone:970-255-8037
Practice Address - Fax:970-424-5013
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist