Provider Demographics
NPI:1356642102
Name:MARTIN, RONALD BERNARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BERNARD
Last Name:MARTIN
Suffix:JR
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 1:3240 CLOVER BLOSSOM CIR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7990
Mailing Address - Country:US
Mailing Address - Phone:609-304-8117
Mailing Address - Fax:609-304-8117
Practice Address - Street 1:15993 PRESERVE MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-5509
Practice Address - Country:US
Practice Address - Phone:609-304-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00693600111N00000X
FLCH12488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor