Provider Demographics
NPI:1245240175
Name:MARTINEZ, DAVID CLARK (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLARK
Last Name:MARTINEZ
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 1:1100 S E LOUIS BLVD
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110
Mailing Address - Country:US
Mailing Address - Phone:316-777-9200
Mailing Address - Fax:316-777-0393
Practice Address - Street 1:1100 S E LOUIS BLVD
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110
Practice Address - Country:US
Practice Address - Phone:316-777-9200
Practice Address - Fax:316-777-0393
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4588319OtherAETNA US HEALTHCARE
U29752Medicare UPIN
KS4588319OtherAETNA US HEALTHCARE