Provider Demographics
NPI:1093824245
Name:MARTIN, GREGORY KYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KYLE
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 1:460 228TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7209
Mailing Address - Country:US
Mailing Address - Phone:425-868-9025
Mailing Address - Fax:425-432-1449
Practice Address - Street 1:460 228TH AVE NE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7209
Practice Address - Country:US
Practice Address - Phone:142-586-8902
Practice Address - Fax:142-543-2144
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor