Marque Medicos Kedzie, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

MARQUE MEDICOS KEDZIE, LLC

Practice address

5825 S Kedzie Ave
Chicago, IL 60629-3212

Phone

(773) 283-3131

Fax

(773) 283-3610

NPI assigned

Jun 16, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Derrick D. Wallery, D.C.

Title

Manager

Phone

(773) 283-3131

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1194985747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4176 W MONTROSE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412161",
            "telephone_number": "773-283-3131",
            "fax_number": "773-283-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5825 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606293212",
            "telephone_number": "773-283-3131",
            "fax_number": "773-283-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARQUE MEDICOS KEDZIE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "WALLERY",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "773-283-3131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Dawn Gosha Marquardt, RN
• Katie Marquardt, RD
• Marque Medicos 26TH Street, LLC.
• Marque Medicos Archer, LLC
• Marque Medicos Fullerton, LLC
• Danilo Marques Nogueira, M.D.
• Mitchell Albert Marques, MD
• Marquette Orthopedic LTD
• Marquette Radiology Associates LLC
• Alondra Marquez-Gonzalez, MA

• Chiropractor in Chicago, IL
• Providers in Chicago, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.