Provider Demographics
NPI:1679212633
Name:MAYERSON, MARLA K (DC)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:K
Last Name:MAYERSON
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 1:5502 WASHINGTON AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4094
Mailing Address - Country:US
Mailing Address - Phone:262-394-8190
Mailing Address - Fax:
Practice Address - Street 1:5502 WASHINGTON AVE STE 700
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4094
Practice Address - Country:US
Practice Address - Phone:262-394-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-28
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5739-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty