Organization
MARQUE MEDICOS KEDZIE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERRICK D. WALLERY D.C. (MANAGER)
(773) 283-3131
Entity
Organization
Contact information
Practice address
5825 S KEDZIE AVE, CHICAGO, IL 60629-3212
(773) 283-3131
(773) 283-3610
Mailing address
4176 W MONTROSE AVE, CHICAGO, IL 60641-2161
(773) 283-3131
(773) 283-3610
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
06/16/2008
Last updated
06/16/2008
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