Provider Demographics
NPI:1386003416
Name:MARTINEZ, SCOTT JOSEPH JR (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JOSEPH
Last Name:MARTINEZ
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 1:1828 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4938
Mailing Address - Country:US
Mailing Address - Phone:318-547-6531
Mailing Address - Fax:
Practice Address - Street 1:1828 TOWER DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4938
Practice Address - Country:US
Practice Address - Phone:318-547-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor