Provider Demographics
NPI: | 1265673909 |
---|---|
Name: | ELLIOT J MARTIN CHIROPRACTIC PC |
Entity Type: | Organization |
Organization Name: | ELLIOT J MARTIN CHIROPRACTIC PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ELLIOT |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | MARTIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 518-697-9701 |
Mailing Address - Street 1: | 2139 COUNTY ROUTE 21 |
Mailing Address - Street 2: | |
Mailing Address - City: | VALATIE |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12184-3116 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 518-697-9701 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3143 U S ROUTE 9 |
Practice Address - Street 2: | SUITE 4 |
Practice Address - City: | VALATIE |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12184 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-697-9701 |
Practice Address - Fax: | 518-773-1162 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-03-10 |
Last Update Date: | 2024-01-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | X0070681 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |