Marvin Harry Mortensen, DC
Individual provider Active NPI Chiropractor · Brandon, WI
NPI 1215098249 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215098249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2003012 (WI)
- Practice address
- 162 E Main St
Mortensen Chiropractic Office
Brandon, WI 53919 - Phone
- (920) 346-5286
- NPI assigned
- Dec 13, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2003012 | WI | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2003012 | WI | Yes |
Addresses
Primary practice location
162 E Main St
Mortensen Chiropractic Office
Brandon, WI 53919
Mailing address
PO Box 277
162 E Main St
Brandon, WI 53919
Phone (920) 346-5286
Other providers in Brandon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.