Provider Demographics
NPI:1275745861
Name:MARTIN CHIROPRACTIC GROUP, PSC
Entity Type:Organization
Organization Name:MARTIN CHIROPRACTIC GROUP, PSC
Other - Org Name:LOUISVILLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-489-8480
Mailing Address - Street 1:138 EVERGREEN RD
Mailing Address - Street 2:STE 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1410
Mailing Address - Country:US
Mailing Address - Phone:502-489-8480
Mailing Address - Fax:
Practice Address - Street 1:138 EVERGREEN RD
Practice Address - Street 2:STE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1410
Practice Address - Country:US
Practice Address - Phone:502-489-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00579Medicare PIN
KYV06335Medicare UPIN