Provider Demographics
NPI:1083712624
Name:ST MARTIN, DOUGLAS P (CH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:P
Last Name:ST MARTIN
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 GARLINGTON RD STE G
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5435
Mailing Address - Country:US
Mailing Address - Phone:864-281-9393
Mailing Address - Fax:864-281-9394
Practice Address - Street 1:700 GARLINGTON RD STE G
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5435
Practice Address - Country:US
Practice Address - Phone:864-281-9393
Practice Address - Fax:864-281-9394
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8588Medicare PIN
V08377Medicare UPIN