Provider Demographics
NPI:1275778854
Name:MARTIN, DUSTIN GARRETT (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:GARRETT
Last Name:MARTIN
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 1:1910 N 12TH ST
Mailing Address - Street 2:STE F
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2912
Mailing Address - Country:US
Mailing Address - Phone:970-241-1199
Mailing Address - Fax:970-241-2047
Practice Address - Street 1:1910 N 12TH ST
Practice Address - Street 2:STE F
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2912
Practice Address - Country:US
Practice Address - Phone:970-241-1199
Practice Address - Fax:970-241-2047
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO304767Medicare PIN