Provider Demographics
NPI:1144574559
Name:MARTINEZ, NATALIE (DC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12107 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-1025
Mailing Address - Country:US
Mailing Address - Phone:708-646-6687
Mailing Address - Fax:
Practice Address - Street 1:6326 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2313
Practice Address - Country:US
Practice Address - Phone:708-660-9070
Practice Address - Fax:708-660-9565
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor