Provider Demographics
NPI:1043508542
Name:MARTIN, BRETT THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:THOMAS
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 1:206 W NOLANA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2513
Mailing Address - Country:US
Mailing Address - Phone:956-682-7351
Mailing Address - Fax:956-630-1033
Practice Address - Street 1:206 W NOLANA AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2513
Practice Address - Country:US
Practice Address - Phone:956-682-7351
Practice Address - Fax:956-630-1033
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A6036Medicare UPIN