Marque Medicos Fullerton, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038008088 Issued in IL

Legal business name

MARQUE MEDICOS FULLERTON, LLC

Practice address

3735 W Fullerton Ave
Chicago, IL 60647-2357

Phone

(773) 283-3131

Fax

(773) 283-3610

NPI assigned

Jan 6, 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

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

{
    "created_epoch": "1231200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231200000000",
    "number": "1831335355",
    "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": "3735 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472357",
            "telephone_number": "773-283-3131",
            "fax_number": "773-283-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARQUE MEDICOS FULLERTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-06",
        "last_updated": "2009-01-06",
        "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": []
}

• Rachael Marquard, LCSW
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• Katie Marquardt, RD
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• Marque Medicos Archer, LLC
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• Danilo Marques Nogueira, M.D.
• Mitchell Albert Marques, MD
• Marquette Orthopedic LTD
• Marquette Radiology Associates LLC

• 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 6, 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.