Provider Demographics
NPI:1205010832
Name:MARTINEZ, RUTH (DC)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:HARSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:25 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2501
Mailing Address - Country:US
Mailing Address - Phone:435-621-6664
Mailing Address - Fax:
Practice Address - Street 1:25 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2501
Practice Address - Country:US
Practice Address - Phone:435-621-6664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT164766-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor