Individual provider Active NPI

Marla K Mayerson, DC

  • Chiropractor
  • Milwaukee, WI
National Provider Identifier
1679212633
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5739-12 Issued in WI
Practice address
3064 S Kinnickinnic Ave
Milwaukee, WI 53207-2966
Phone
(414) 747-8822
NPI assigned
May 28, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 5739-12 WI Primary

Addresses

Primary practice location

3064 S Kinnickinnic Ave
Milwaukee, WI 53207-2966

Mailing address

701 River Ridge Dr
Waterford, WI 53185-3386
Phone (414) 747-8822

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250429003374 WI Practitioner - Chiropractic 2264958537 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3064 S Kinnickinnic Ave
Milwaukee, WI 53207-2966

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5739-12WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Chiropractic Resonance and Integrative Nutrition, LLC Chiropractor CurrentSince Apr 13, 2025 Accepting new patients

Locations

3064 S Kinnickinnic Ave
Milwaukee, WI 53207
Phone (414) 747-8822

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1653696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1679212633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 RIVER RIDGE DR",
            "city": "WATERFORD",
            "state": "WI",
            "postal_code": "531853386",
            "telephone_number": "414-747-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3064 S KINNICKINNIC AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532072966",
            "telephone_number": "414-747-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYERSON",
        "first_name": "MARLA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-28",
        "last_updated": "2025-03-05",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "5739-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.