Provider Demographics
NPI:1619012333
Name:MARKS, KEITH LYNCH (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LYNCH
Last Name:MARKS
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:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:WI
Mailing Address - Zip Code:54448-0071
Mailing Address - Country:US
Mailing Address - Phone:715-443-6777
Mailing Address - Fax:715-443-3177
Practice Address - Street 1:117 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:WI
Practice Address - Zip Code:54448-9646
Practice Address - Country:US
Practice Address - Phone:715-443-6777
Practice Address - Fax:715-443-3177
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38897800Medicaid
WI38897800Medicaid
WIU65036Medicare UPIN