Marque Medicos 26TH Street, LLC.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038008088 Issued in IL

Legal business name

MARQUE MEDICOS 26TH STREET, LLC.

Practice address

3501 W 26TH St
Chicago, IL 60623-3910

Phone

(773) 283-3131

Fax

(773) 283-3610

NPI assigned

Jan 5, 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": "1231113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231113600000",
    "number": "1528204088",
    "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": "3501 W 26TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606233910",
            "telephone_number": "773-283-3131",
            "fax_number": "773-283-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARQUE MEDICOS 26TH STREET, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-05",
        "last_updated": "2009-01-05",
        "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": []
}

• John Marovic
• Mary Louise Marovich
• Rachael Marquard, LCSW
• Jennifer Dawn Gosha Marquardt, RN
• Katie Marquardt, RD
• Marque Medicos Archer, LLC
• Marque Medicos Fullerton, LLC
• Marque Medicos Kedzie, LLC
• Danilo Marques Nogueira, M.D.
• Mitchell Albert Marques, MD

• 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 Jan 5, 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.