Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038.013610 | IL |
N | 111N00000X | Chiropractor | DC-05001 | OH |
N | 111NR0400X | Rehabilitation Chiropractor | 038.013610 | IL |
NPI | 1407454424 |
---|---|
Provider Name | Mikel Marshall |
First Address | Wheaton, IL 60189-6924 |
Second Address | Wheaton, IL 60189-6924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2020 |
Last Update Date | 12/10/2020 |