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General NPI Number Information
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NPI Number | 1245536150
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Entity Type | Organization
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Legal Business Name | MAREK CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 4700 LEXINGTON AVE N SUITE D
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City | SHOREVIEW
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State | MN
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Zip | 55126-5867
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Country | US
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Telephone | 651-784-4545
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Fax | 651-483-5264
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Provider Business Mailing Address
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Address Line | 4700 LEXINGTON AVE N SUITE D
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City | SHOREVIEW
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State | MN
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Zip | 55126-5867
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Country | US
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Telephone | 651-784-4545
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Fax | 651-483-5264
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Authorized Official
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Title or Position | OWNER
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Name | DR. LORI LYNN MAREK
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Credential | D.C.
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Telephone | 651-784-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2619
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License Number State | MN
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