Provider Demographics
NPI:1043430234
Name:MARTIN, WILLIAM O (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:O
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 1:141 SOUTH AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1225
Mailing Address - Country:US
Mailing Address - Phone:908-322-7400
Mailing Address - Fax:908-322-7401
Practice Address - Street 1:141 SOUTH AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1225
Practice Address - Country:US
Practice Address - Phone:908-322-7400
Practice Address - Fax:908-322-7401
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00131300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45107Medicare UPIN
NJ450138Medicare ID - Type UnspecifiedMEDICARE