Organization
MARQUE MEDICOS 26TH STREET, 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
3501 W 26TH ST, CHICAGO, IL 60623-3910
(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
038008088
IL
Other
Enumeration date
01/05/2009
Last updated
01/05/2009
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