Healthcare Provider Details

I. General information

NPI: 1497812267
Provider Name (Legal Business Name): BRIAN KEITH MARQUEZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 BROWNSBORO RD
LOUISVILLE KY
40241-5230
US

IV. Provider business mailing address

9811 BROWNSBORO RD
LOUISVILLE KY
40241-5230
US

V. Phone/Fax

Practice location:
  • Phone: 502-327-6000
  • Fax: 502-327-6009
Mailing address:
  • Phone: 502-327-6000
  • Fax: 502-327-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4785
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number4785
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number4785
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number4785
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4785
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number4785
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: