Individual provider Active NPI

Marty Jon Lorentz, DC

  • Chiropractor
  • Onalaska, WI
National Provider Identifier
1417990722
Registry record updated Mar 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3375 Issued in WI
Practice address
2850 National Dr
Ste 105
Onalaska, WI 54650-6732
Phone
(608) 519-5767
Fax
(608) 519-5768
NPI assigned
Jun 14, 2006
Last updated
Mar 26, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3375 WI Primary

Addresses

Primary practice location

2850 National Dr
Ste 105
Onalaska, WI 54650-6732

Mailing address

2850 National Dr
Ste 105
Onalaska, WI 54650-6732
Phone (608) 519-5767

Other identifiers 2

IdentifierTypeStateIssuer
P00108135OtherWIRAILROAD MEDICARE PIN
38898200MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050331001238 WI Practitioner - Chiropractic 6002863149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2850 National Dr
Suite 105
Onalaska, WI 54650-6733
Phone (608) 519-5767

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Three Rivers Chiropractic LLC Chiropractor PastSince Mar 15, 2003 Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395792000000",
    "number": "1417990722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 NATIONAL DR",
            "address_2": "STE 105",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546506732",
            "telephone_number": "608-519-5767",
            "fax_number": "608-519-5768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 NATIONAL DR",
            "address_2": "STE 105",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546506732",
            "telephone_number": "608-519-5767",
            "fax_number": "608-519-5768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LORENTZ",
        "first_name": "MARTY",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2014-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "P00108135",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38898200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Onalaska, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.