Provider Demographics
NPI:1043222995
Name:MARTIN, ROBERT DONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DONALD
Last Name:MARTIN
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 1:217 E BROADWAY BLVD
Mailing Address - Street 2:P.O. BOX 267
Mailing Address - City:JOHNSTON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62951-1604
Mailing Address - Country:US
Mailing Address - Phone:618-983-3900
Mailing Address - Fax:
Practice Address - Street 1:217 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTON CITY
Practice Address - State:IL
Practice Address - Zip Code:62951-1604
Practice Address - Country:US
Practice Address - Phone:619-983-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 111NR0200X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0200XChiropractic ProvidersChiropractorRadiology
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL073-82002OtherBLUE CROSS/BLUE SHIELD
ILT43086Medicare UPIN
IL948240Medicare ID - Type Unspecified