Healthcare Provider Details

I. General information

NPI: 1295079838
Provider Name (Legal Business Name): JOEL STUART MARTENSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 9TH ST
AURORA NE
68818-1259
US

IV. Provider business mailing address

1619 9TH ST
AURORA NE
68818-1259
US

V. Phone/Fax

Practice location:
  • Phone: 402-694-6501
  • Fax: 402-694-6504
Mailing address:
  • Phone: 402-694-6501
  • Fax: 402-694-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1774
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: