Provider Demographics
NPI:1275831844
Name:MART, MALACHI JAPHETH (DC)
Entity Type:Individual
Prefix:DR
First Name:MALACHI
Middle Name:JAPHETH
Last Name:MART
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 1:10761 RETREAT LN
Mailing Address - Street 2:#4
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-6921
Mailing Address - Country:US
Mailing Address - Phone:612-770-5117
Mailing Address - Fax:
Practice Address - Street 1:10761 RETREAT LN
Practice Address - Street 2:#4
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-6921
Practice Address - Country:US
Practice Address - Phone:612-770-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor