Healthcare Provider Details

I. General information

NPI: 1770720013
Provider Name (Legal Business Name): BRIAN MARION D.C., A.R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 N LINCOLN AVE SUITE 1
CHICAGO IL
60614-7170
US

IV. Provider business mailing address

2202 N LINCOLN AVE SUITE 1
CHICAGO IL
60614-7170
US

V. Phone/Fax

Practice location:
  • Phone: 248-891-9099
  • Fax: 773-248-2058
Mailing address:
  • Phone:
  • Fax: 773-248-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.011329
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: