Provider Demographics
NPI:1245536150
Name:MAREK CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:MAREK CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-784-4545
Mailing Address - Street 1:4700 LEXINGTON AVE N
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5867
Mailing Address - Country:US
Mailing Address - Phone:651-784-4545
Mailing Address - Fax:651-483-5264
Practice Address - Street 1:4700 LEXINGTON AVE N
Practice Address - Street 2:SUITE D
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5867
Practice Address - Country:US
Practice Address - Phone:651-784-4545
Practice Address - Fax:651-483-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty