MEDICARE: DR. STEPHEN L. MARTY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1757	MN

General Provider Information

NPI Number	:	1003029851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN L. MARTY D.C.

Provider Business Mailing Address
First Line	:	5910 SCENIC HEIGHTS DR
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-6311
Country	:	US
Telephone Number	:	952-934-6805
Fax Number	:

Provider Business Practice Location Address
First Line	:	6409 CITY WEST PKWY STE 105
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7845
Country	:	US
Telephone Number	:	952-833-3038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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