Provider Demographics
NPI:1164593422
Name:MARTIN, ROBERT R (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
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 1:6832 HUMBOLDT AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1536
Mailing Address - Country:US
Mailing Address - Phone:763-560-6360
Mailing Address - Fax:763-560-0792
Practice Address - Street 1:6832 HUMBOLDT AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1536
Practice Address - Country:US
Practice Address - Phone:763-560-6360
Practice Address - Fax:763-560-0792
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor