Provider Demographics
NPI:1932167301
Name:MARTY, WILLIAM LUKE (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LUKE
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 1:17 TENTH 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:952-927-0178
Practice Address - Street 1:17 TENTH 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:952-927-0178
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN42G88MAOtherBC
MN56258900Medicaid
MN56258900Medicaid