Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1757 | MN |
NPI | 1003029851 |
---|---|
Provider Name | Dr. Stephen L. Marty |
First Address | Minnetonka, MN 55345-6311 |
Second Address | Eden Prairie, MN 55344-7845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |