Provider Demographics
NPI:1114955192
Name:MARTIN, MICHAEL JOSEPH (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7839 WISE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-3339
Mailing Address - Country:US
Mailing Address - Phone:410-288-1800
Mailing Address - Fax:410-288-1818
Practice Address - Street 1:7839 WISE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-3339
Practice Address - Country:US
Practice Address - Phone:410-288-1800
Practice Address - Fax:410-288-1818
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01387111N00000X
PA3485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM494OtherCAREFIRST BLUE CROSS
MDW2960001OtherCAREFIRST BLUE CHOICE
MD128138100Medicaid
MDW2960001OtherCAREFIRST BLUE CHOICE
MD128138100Medicaid