MEDICARE: DR. BRIAN LEE MAREK D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4738-012	WI
2	111N00000X	Chiropractor	038011967	IL
3	111N00000X	Chiropractor	12363	TX

General Provider Information

NPI Number	:	1003101593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN LEE MAREK D.C.

Provider Business Mailing Address
First Line	:	2660 N HASKELL AVE
Second Line	:	3158
City	:	DALLAS
State	:	TX
Zip	:	75204-2918
Country	:	US
Telephone Number	:	469-404-9116
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 S BUCKNER BLVD
Second Line	:	200
City	:	DALLAS
State	:	TX
Zip	:	75227-2373
Country	:	US
Telephone Number	:	214-381-7700
Fax Number	:	214-381-5510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	06/14/2013

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