Provider Demographics
NPI:1497812267
Name:MARQUEZ, BRIAN KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 BROWNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-5230
Mailing Address - Country:US
Mailing Address - Phone:502-327-6000
Mailing Address - Fax:502-327-6009
Practice Address - Street 1:9811 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-5230
Practice Address - Country:US
Practice Address - Phone:502-327-6000
Practice Address - Fax:502-327-6009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4785111N00000X, 111NI0013X, 111NR0200X, 111NX0100X, 111NR0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000378306OtherANTHEM BLUE CROSS BLUE SH
611414018OtherHUMANA
611414018BOtherHUMANA
KY85003135Medicaid
50007024OtherPASSPORT
6114140180003OtherCIGNA HEALTH CARE
653884OtherBLUEGRASS FAMILY HEALTH
653884OtherMAIL HANDLERS
653884OtherUHC OF KENTUCKY
07815453OtherAETNA
11210338OtherCAQH
KY2448199000OtherPASSPORT ADVANTAGE
653884OtherGE WELLNESS PLAN
KYU95573Medicare UPIN
KY85003135Medicaid