Provider Demographics
NPI:1003029851
Name:MARTY, STEPHEN L (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:MARTY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 SCENIC HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-6311
Mailing Address - Country:US
Mailing Address - Phone:952-934-6805
Mailing Address - Fax:
Practice Address - Street 1:6409 CITY WEST PKWY STE 105
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7845
Practice Address - Country:US
Practice Address - Phone:952-833-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor