Provider Demographics
NPI:1205178126
Name:MARICK CHIROPRACTIC SERVICES, P.C.
Entity Type:Organization
Organization Name:MARICK CHIROPRACTIC SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-533-0815
Mailing Address - Street 1:2424 PEDDLERS VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-5778
Mailing Address - Country:US
Mailing Address - Phone:574-533-0815
Mailing Address - Fax:
Practice Address - Street 1:2424 PEDDLERS VILLAGE RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-5778
Practice Address - Country:US
Practice Address - Phone:574-533-0815
Practice Address - Fax:574-533-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN51000091A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty