Provider Demographics
NPI:1386835536
Name:MAREK CHIROPRACTIC INCORPORATED
Entity Type:Organization
Organization Name:MAREK CHIROPRACTIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-327-4253
Mailing Address - Street 1:101 UNITED WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERIC
Mailing Address - State:WI
Mailing Address - Zip Code:54837-9052
Mailing Address - Country:US
Mailing Address - Phone:715-327-4253
Mailing Address - Fax:715-327-4270
Practice Address - Street 1:101 UNITED WAY
Practice Address - Street 2:
Practice Address - City:FREDERIC
Practice Address - State:WI
Practice Address - Zip Code:54837-9052
Practice Address - Country:US
Practice Address - Phone:715-327-4253
Practice Address - Fax:715-327-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3097-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38878700Medicaid