Provider Demographics
NPI:1326109919
Name:MICHAEL R MARTIN DC PC
Entity Type:Organization
Organization Name:MICHAEL R MARTIN DC PC
Other - Org Name:MARTIN CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-867-1500
Mailing Address - Street 1:1212 COIT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7740
Mailing Address - Country:US
Mailing Address - Phone:972-867-1500
Mailing Address - Fax:972-867-5968
Practice Address - Street 1:1212 COIT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7740
Practice Address - Country:US
Practice Address - Phone:972-867-1500
Practice Address - Fax:972-867-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4251787OtherAETNA ID
TX0023PYOtherBLUE CROSS BLUE SHIELD
TX50552OtherFIRST HEALTH
TX0023PYOtherBLUE CROSS BLUE SHIELD
TX=========OtherTAX ID
TXT14610Medicare UPIN