Active NPI
Phillip Mark Marty, DC
- Chiropractor
- Excelsior, MN
National Provider Identifier
1275547689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2470
- Practice address
- 464 Second Street
Ste 200
Excelsior, MN 55331 - Phone
- (952) 474-4121
- Fax
- (952) 474-8391
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2470 | MN | Primary |
Addresses
Primary practice location
464 Second Street
Ste 200
Excelsior, MN 55331
Mailing address
464 Second Street
Ste 200
Excelsior, MN 55331
Phone (952) 474-4121
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1D866MA | Other | MN | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111026000045 | MN | Practitioner - Chiropractic | 3577554831 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2470 | MN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275547689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "464 SECOND STREET",
"address_2": "STE 200",
"city": "EXCELSIOR",
"state": "MN",
"postal_code": "55331",
"telephone_number": "952-474-4121",
"fax_number": "952-474-8391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "464 SECOND STREET",
"address_2": "STE 200",
"city": "EXCELSIOR",
"state": "MN",
"postal_code": "55331",
"telephone_number": "952-474-4121",
"fax_number": "952-474-8391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTY",
"first_name": "PHILLIP",
"middle_name": "MARK",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "2470",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1D866MA",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Excelsior, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.