Provider Demographics
NPI:1700904422
Name:MARKLEY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:MARKLEY CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-866-3491
Mailing Address - Street 1:311 E DREXEL PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-7294
Mailing Address - Country:US
Mailing Address - Phone:219-866-3491
Mailing Address - Fax:219-866-8800
Practice Address - Street 1:311 E DREXEL PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-7294
Practice Address - Country:US
Practice Address - Phone:219-866-3491
Practice Address - Fax:219-866-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100070840CMedicaid
INT34553Medicare UPIN