MEDICARE: MAREK CHIROPRACTIC, LLC

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	2619	MN

General Provider Information

NPI Number	:	1245536150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAREK CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	4700 LEXINGTON AVE N
Second Line	:	SUITE D
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-5867
Country	:	US
Telephone Number	:	651-784-4545
Fax Number	:	651-483-5264

Provider Business Practice Location Address
First Line	:	4700 LEXINGTON AVE N
Second Line	:	SUITE D
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-5867
Country	:	US
Telephone Number	:	651-784-4545
Fax Number	:	651-483-5264

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LORI LYNN MAREK
Credential	:	D.C.
Telephone Number	:	651-784-4545

Provider Enumeration Date	:	02/10/2011
Last Update Date	:	02/10/2011

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