Provider Demographics
NPI:1336286665
Name:MARTIN, JOHN KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEVIN
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 1:37053-B. PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769
Mailing Address - Country:US
Mailing Address - Phone:225-673-6454
Mailing Address - Fax:225-673-5488
Practice Address - Street 1:37053-B. PERKINS RD
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769
Practice Address - Country:US
Practice Address - Phone:225-673-6454
Practice Address - Fax:225-673-5488
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor