Healthcare Provider Details

I. General information

NPI: 1457338139
Provider Name (Legal Business Name): JOSEPH L MAREK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 UNITED WAY
FREDERIC WI
54837
US

IV. Provider business mailing address

PO BOX 249 101 UNITED WAY
FREDERIC WI
54837-0249
US

V. Phone/Fax

Practice location:
  • Phone: 715-327-4253
  • Fax: 715-327-4253
Mailing address:
  • Phone: 715-327-4253
  • Fax: 715-327-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3097
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: