Provider Demographics
NPI:1215587233
Name:JACK K MARTIN DC PLLC
Entity Type:Organization
Organization Name:JACK K MARTIN DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-668-6750
Mailing Address - Street 1:12900 S US HIGHWAY 27 STE 1A
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8340
Mailing Address - Country:US
Mailing Address - Phone:517-668-6750
Mailing Address - Fax:517-668-6751
Practice Address - Street 1:12900 S US HIGHWAY 27 STE 1A
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8340
Practice Address - Country:US
Practice Address - Phone:517-668-6750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty