Provider Demographics
NPI:1235006115
Name:GOLDEN, MARTY LYNNE (LAC)
Entity type:Individual
Prefix:
First Name:MARTY
Middle Name:LYNNE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 E DOUGLAS AVE STE 60
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3740
Mailing Address - Country:US
Mailing Address - Phone:316-518-0050
Mailing Address - Fax:
Practice Address - Street 1:3700 E DOUGLAS AVE STE 60
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3740
Practice Address - Country:US
Practice Address - Phone:316-518-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS-2300044171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty