Jeremy Glen Marty, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6189 Issued in MN

Practice address

18476 Kenrick Ave
Suite 201
Lakeville, MN 55044-9288

Phone

(612) 440-5776

Fax

(952) 236-6732

NPI assigned

Jan 25, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marty Chiropractic & Wellness LLC

  • Chiropractor
  • Lakeville, MN
  • NPI 1043761133
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477267200000",
    "number": "1104283928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18476 KENRICK AVE",
            "address_2": "SUITE 201",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449288",
            "telephone_number": "612-440-5776",
            "fax_number": "952-236-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18476 KENRICK AVE",
            "address_2": "SUITE 201",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449288",
            "telephone_number": "612-440-5776",
            "fax_number": "952-236-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTY",
        "first_name": "JEREMY",
        "middle_name": "GLEN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-25",
        "last_updated": "2016-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark S Mellstrom MD PA
• Mark S Mellstrom, MD, PA
• Stephanie Market
• Eugene Gary Martens, M.S.E., LMFT
• Marty Chiropractic & Wellness LLC
• Joshua Marty, D.C.
• Hector Rene Matascastillo, MSW, LICSW, LSSW
• Sybilla Materla
• Trudy M Matthys, RPH
• Andrew Mattson, O.D.

• All providers in Lakeville, MN
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.