Provider Demographics
NPI:1952119489
Name:MARTEN, JACKSON (DC)
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:MARTEN
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 1:2800 RUSTIC PL APT 209
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1398
Mailing Address - Country:US
Mailing Address - Phone:712-269-5901
Mailing Address - Fax:
Practice Address - Street 1:3570 LEXINGTON AVE N STE 208
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8058
Practice Address - Country:US
Practice Address - Phone:651-400-7026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor