Provider Demographics
NPI:1669923413
Name:MARTY CHIROPRACTIC HOPKINS P.A.
Entity type:Organization
Organization Name:MARTY CHIROPRACTIC HOPKINS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-205-0165
Mailing Address - Street 1:17 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7505
Mailing Address - Country:US
Mailing Address - Phone:952-927-6639
Mailing Address - Fax:763-568-7347
Practice Address - Street 1:17 10TH AVE S
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7505
Practice Address - Country:US
Practice Address - Phone:952-927-6639
Practice Address - Fax:763-568-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty