Individual
PHILLIP MARK MARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
464 SECOND STREET, STE 200, EXCELSIOR, MN 55331
(952) 474-4121
(952) 474-8391
Mailing address
464 SECOND STREET, STE 200, EXCELSIOR, MN 55331
(952) 474-4121
(952) 474-8391
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2470
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1D866MA
BCBS
MN
Enumeration date
07/28/2006
Last updated
07/08/2007
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