Provider Demographics
NPI:1386922987
Name:MAREK CLINIC OF CHIROPRACTIC, L.L.C.
Entity type:Organization
Organization Name:MAREK CLINIC OF CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-843-4786
Mailing Address - Street 1:6425 ODANA RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1127
Mailing Address - Country:US
Mailing Address - Phone:608-819-8990
Mailing Address - Fax:
Practice Address - Street 1:6425 ODANA RD
Practice Address - Street 2:SUITE 14
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1127
Practice Address - Country:US
Practice Address - Phone:608-819-8990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-30
Last Update Date:2011-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4738-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty