Provider Demographics
NPI:1225618721
Name:MARCINIK, WRENDY DAWN (DC)
Entity Type:Individual
Prefix:
First Name:WRENDY
Middle Name:DAWN
Last Name:MARCINIK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3869 OSAGE BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-2158
Mailing Address - Country:US
Mailing Address - Phone:573-569-5193
Mailing Address - Fax:
Practice Address - Street 1:3869 OSAGE BEACH PKWY
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-2158
Practice Address - Country:US
Practice Address - Phone:573-569-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019040877111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition