1073571378 NPI number — DR. MARIN KAY WENDELL D.C.

Table of content: DR. MARIN KAY WENDELL D.C. (NPI 1073571378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073571378 NPI number — DR. MARIN KAY WENDELL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WENDELL
Provider First Name:
MARIN
Provider Middle Name:
KAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAMETTI
Provider Other First Name:
MARIN
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073571378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89801-3614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-777-3033
Provider Business Mailing Address Fax Number:
775-777-3045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 E DANA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-274-0777
Provider Business Practice Location Address Fax Number:
605-274-0778
Provider Enumeration Date:
05/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1082 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)