Provider Demographics
NPI:1225103146
Name:MARKLEY, JERRY LYNN (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:LYNN
Last Name:MARKLEY
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 DREXEL PARKWAY
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:RENSELLAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978
Mailing Address - Country:US
Mailing Address - Phone:219-866-3491
Mailing Address - Fax:219-866-8800
Practice Address - Street 1:311 DREXEL PARKWAY
Practice Address - Street 2:SUITE # 1
Practice Address - City:RENSELLAER
Practice Address - State:IN
Practice Address - Zip Code:47978
Practice Address - Country:US
Practice Address - Phone:219-866-3491
Practice Address - Fax:219-866-8800
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000942A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT34553Medicare UPIN
IN184960AMedicare ID - Type Unspecified