Active NPI
Michael Leonard Marty, D.C.
- Chiropractor
- Kimball, MN
National Provider Identifier
1619978798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2068
- Practice address
- 510 Hwy 55 East
Kimball, MN 55353 - Phone
- (320) 398-7900
- Fax
- (320) 398-7902
- NPI assigned
- Aug 10, 2005
- Last updated
- Jan 17, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 | 2068 | MN | Primary |
Addresses
Primary practice location
510 Hwy 55 East
Kimball, MN 55353
Mailing address
PO Box 371
Kimball, MN 55353-0371
Phone (320) 398-7900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3K836KI | Other | MN | BLUECROSS BLUE SHIELD |
| 230530 | Other | MN | CHIROCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060124000168 | MN | Practitioner - Chiropractic | 7719901297 | Practice locations: Kimball, MN |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
510 Hwy 55 E
Kimball, MN 55353
Phone (320) 398-7900
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2068 | MN | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200528000000",
"number": "1619978798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 371",
"city": "KIMBALL",
"state": "MN",
"postal_code": "553530371",
"telephone_number": "320-398-7900",
"fax_number": "320-398-7902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 HWY 55 EAST",
"city": "KIMBALL",
"state": "MN",
"postal_code": "55353",
"telephone_number": "320-398-7900",
"fax_number": "320-398-7902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTY",
"first_name": "MICHAEL",
"middle_name": "LEONARD",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-10",
"last_updated": "2008-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "2068",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUE SHIELD",
"identifier": "3K836KI",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHIROCARE",
"identifier": "230530",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kimball, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2008; 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.