Provider Demographics
NPI:1366073827
Name:MARTY, JUSTIN B (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:B
Last Name:MARTY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 VIRGINIA AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-1968
Mailing Address - Country:US
Mailing Address - Phone:320-282-3825
Mailing Address - Fax:
Practice Address - Street 1:7301 OHMS LN STE 430
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2376
Practice Address - Country:US
Practice Address - Phone:952-479-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor