Provider Demographics
NPI:1053448316
Name:MARTIN, MICHAEL C (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
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 1:5355 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226
Mailing Address - Country:US
Mailing Address - Phone:480-705-0353
Mailing Address - Fax:480-699-0353
Practice Address - Street 1:5355 W CHANDLER BLVD
Practice Address - Street 2:SUITE 10 DRIFTWOOD FAMILY CHIROPRACTIC
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226
Practice Address - Country:US
Practice Address - Phone:480-705-0353
Practice Address - Fax:480-699-0353
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2128894OtherAETNA
AZ61101OtherHUMANA
AZ61101OtherHUMANA