Marque Medicos Archer, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038008088 Issued in IL

Legal business name

MARQUE MEDICOS ARCHER, LLC

Practice address

4195 S Archer Ave
Chicago, IL 60632-1849

Phone

(773) 283-3131

Fax

(773) 283-3610

NPI assigned

Feb 19, 2009

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": "1235001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235001600000",
    "number": "1366681025",
    "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": "4195 S ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606321849",
            "telephone_number": "773-283-3131",
            "fax_number": "773-283-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARQUE MEDICOS ARCHER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-19",
        "last_updated": "2009-02-19",
        "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": "IL",
            "license": "038008088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Louise Marovich
• Rachael Marquard, LCSW
• Jennifer Dawn Gosha Marquardt, RN
• Katie Marquardt, RD
• Marque Medicos 26TH Street, LLC.
• Marque Medicos Fullerton, LLC
• Marque Medicos Kedzie, LLC
• Danilo Marques Nogueira, M.D.
• Mitchell Albert Marques, MD
• Marquette Orthopedic LTD

• 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 Feb 19, 2009; 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.