Provider Demographics
NPI:1962125864
Name:MARSHALL FAMILY WELLNESS LLC
Entity type:Organization
Organization Name:MARSHALL FAMILY WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-583-0061
Mailing Address - Street 1:111 W JACKSON BLVD STE 1160
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3896
Mailing Address - Country:US
Mailing Address - Phone:312-583-0061
Mailing Address - Fax:
Practice Address - Street 1:111 W JACKSON BLVD STE 1160
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3896
Practice Address - Country:US
Practice Address - Phone:312-583-0061
Practice Address - Fax:312-583-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty