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General NPI Number Information
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NPI Number | 1750554010
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Entity Type | Organization
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Legal Business Name | MARTY CHIROPRACTIC WELLNESS CENTER, P.C.
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 1310 N IL RT 251
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City | LOSTANT
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State | IL
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Zip | 61334-0207
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Country | US
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Telephone | 815-368-3421
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Fax | 815-368-3404
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Provider Business Mailing Address
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Address Line | 1310 N IL RT 251
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City | LOSTANT
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State | IL
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Zip | 61334-0207
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Country | US
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Telephone | 815-368-3421
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Fax | 815-368-3404
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. RHONDA J MARTY-ANDERSON
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Credential | D.C.
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Telephone | 815-368-3421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | IL
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