MEDICARE: DR. MARLA K MAYERSON DC

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	5739-12	WI

General Provider Information

NPI Number	:	1679212633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARLA K MAYERSON DC

Provider Business Mailing Address
First Line	:	701 RIVER RIDGE DR
Second Line	:
City	:	WATERFORD
State	:	WI
Zip	:	53185-3386
Country	:	US
Telephone Number	:	414-747-8822
Fax Number	:

Provider Business Practice Location Address
First Line	:	3064 S KINNICKINNIC AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2966
Country	:	US
Telephone Number	:	414-747-8822
Fax Number	:

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

Provider Enumeration Date	:	05/28/2022
Last Update Date	:	03/05/2025

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