Provider Demographics
NPI:1235877838
Name:MARTIN, NATASHA RAE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:RAE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29241 SD HIGHWAY 47
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:SD
Mailing Address - Zip Code:57523-5149
Mailing Address - Country:US
Mailing Address - Phone:605-830-0969
Mailing Address - Fax:
Practice Address - Street 1:802 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:SD
Practice Address - Zip Code:57523
Practice Address - Country:US
Practice Address - Phone:605-830-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor