Provider Demographics
NPI:1417990722
Name:LORENTZ, MARTY JON (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTY
Middle Name:JON
Last Name:LORENTZ
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 1:2850 NATIONAL DR
Mailing Address - Street 2:STE 105
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-6732
Mailing Address - Country:US
Mailing Address - Phone:608-519-5767
Mailing Address - Fax:608-519-5768
Practice Address - Street 1:2850 NATIONAL DR
Practice Address - Street 2:STE 105
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-6732
Practice Address - Country:US
Practice Address - Phone:608-519-5767
Practice Address - Fax:608-519-5768
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00108135OtherRAILROAD MEDICARE PIN
WI38898200Medicaid
WI38898200Medicaid
WIP00108135OtherRAILROAD MEDICARE PIN