Provider Demographics
NPI:1033110366
Name:MARTINEZ, NICOLAS C (DC, FACO)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:C
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DC, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2122
Mailing Address - Country:US
Mailing Address - Phone:630-833-4725
Mailing Address - Fax:630-833-6756
Practice Address - Street 1:3720 W 26TH ST
Practice Address - Street 2:2ND FL.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3824
Practice Address - Country:US
Practice Address - Phone:773-277-2225
Practice Address - Fax:773-277-1134
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
IL111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL162248OtherBLUE CROSS BLUE SHIELD
IL162248OtherBLUE CROSS BLUE SHIELD
ILK16931Medicare ID - Type Unspecified