Provider Demographics
NPI:1396835815
Name:MARTINEZ, JOSEPH LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LOUIS
Last Name:MARTINEZ
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:PO BOX 1931
Mailing Address - Street 2:126 SUMNER AVENUE, 2ND FLOOR
Mailing Address - City:AVALON
Mailing Address - State:CA
Mailing Address - Zip Code:90704-1931
Mailing Address - Country:US
Mailing Address - Phone:310-510-0024
Mailing Address - Fax:310-510-9566
Practice Address - Street 1:126 SUMNER AVE.
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:AVALON
Practice Address - State:CA
Practice Address - Zip Code:90704-1931
Practice Address - Country:US
Practice Address - Phone:310-510-0024
Practice Address - Fax:310-510-9566
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU68290Medicare UPIN