Provider Demographics
NPI:1043491723
Name:MARTIN, DINA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DINA
Other - Middle Name:M
Other - Last Name:MARTIN-RUSK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:27401 LOS ALTOS
Mailing Address - Street 2:SUITE 485
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6316
Mailing Address - Country:US
Mailing Address - Phone:949-215-2000
Mailing Address - Fax:949-831-1762
Practice Address - Street 1:27401 LOS ALTOS
Practice Address - Street 2:SUITE 485
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6316
Practice Address - Country:US
Practice Address - Phone:949-215-2000
Practice Address - Fax:949-831-1762
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24743111NN0400X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition