Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 038011967 | IL |
Y | 111N00000X | Chiropractor | 12363 | TX |
N | 111N00000X | Chiropractor | 4738-012 | WI |
NPI | 1003101593 |
---|---|
Provider Name | Dr. Brian Lee Marek |
First Address | Dallas, TX 75204-2918 |
Second Address | Dallas, TX 75227-2373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2011 |
Last Update Date | 14/06/2013 |