Provider Demographics
NPI:1316213879
Name:MARTIN CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:MARTIN CHIROPRACTIC, INC
Other - Org Name:HEALTHSOURCE OF MARIETTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:FLEMING
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:770-578-0785
Mailing Address - Street 1:3036 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4971
Mailing Address - Country:US
Mailing Address - Phone:770-578-0785
Mailing Address - Fax:
Practice Address - Street 1:3036 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4971
Practice Address - Country:US
Practice Address - Phone:770-578-0785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA41060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty