MEDICARE: MARTY-MCDONALD HEALTH SERVICES, P.A.

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	2894	MN

General Provider Information

NPI Number	:	1598859381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTY-MCDONALD HEALTH SERVICES, P.A.

Provider Business Mailing Address
First Line	:	2424 E 117TH ST
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1269
Country	:	US
Telephone Number	:	952-894-5108
Fax Number	:	952-890-5950

Provider Business Practice Location Address
First Line	:	2424 E 117TH ST
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1269
Country	:	US
Telephone Number	:	952-894-5108
Fax Number	:	952-890-5950

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. KARI J. MCDONALD
Credential	:	D.C.
Telephone Number	:	952-894-5108

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	09/24/2007

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