Provider Demographics
NPI:1356511620
Name:MARTINEZ CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:MARTINEZ CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:DARIO
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-351-0627
Mailing Address - Street 1:1923 59TH AVE UNIT 145
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7976
Mailing Address - Country:US
Mailing Address - Phone:970-351-0627
Mailing Address - Fax:970-351-7950
Practice Address - Street 1:1923 59TH AVE UNIT 145
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7976
Practice Address - Country:US
Practice Address - Phone:970-351-0627
Practice Address - Fax:970-351-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC520998Medicare PIN
COU93870Medicare UPIN