Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 12537 | TX |
Y | 111NR0400X | Rehabilitation Chiropractor | 12537 | TX |
NPI | 1316383037 |
---|---|
Provider Name | Dr. Shaun James Marek |
First Address | Dallas, TX 75230-4636 |
Second Address | Dallas, TX 75232-1353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2013 |
Last Update Date | 07/02/2022 |