Provider Demographics
NPI:1457338139
Name:MAREK, JOSEPH L (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:MAREK
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 249
Mailing Address - Street 2:101 UNITED WAY
Mailing Address - City:FREDERIC
Mailing Address - State:WI
Mailing Address - Zip Code:54837-0249
Mailing Address - Country:US
Mailing Address - Phone:715-327-4253
Mailing Address - Fax:715-327-4270
Practice Address - Street 1:101 UNITED WAY
Practice Address - Street 2:
Practice Address - City:FREDERIC
Practice Address - State:WI
Practice Address - Zip Code:54837
Practice Address - Country:US
Practice Address - Phone:715-327-4253
Practice Address - Fax:715-327-4253
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38878700Medicaid
WI38878700Medicaid
WI70642Medicare ID - Type Unspecified