Provider Demographics
NPI:1407454424
Name:MARSHALL, MIKEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MIKEL
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MIKEL
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:111 W JACKSON BLVD STE 1160
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3896
Mailing Address - Country:US
Mailing Address - Phone:312-583-0061
Mailing Address - Fax:
Practice Address - Street 1:111 W JACKSON BLVD STE 1160
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3896
Practice Address - Country:US
Practice Address - Phone:312-583-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05001111N00000X
IL038.013610111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1962125864OtherTYPE 2 NPI