Provider Demographics
NPI:1417179607
Name:MARTIN, KEVIN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
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 1:7136 MLK JR WAY S
Mailing Address - Street 2:STE 204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3526
Mailing Address - Country:US
Mailing Address - Phone:206-362-3344
Mailing Address - Fax:206-362-3444
Practice Address - Street 1:7136 MLK JR WAY S
Practice Address - Street 2:STE 204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3526
Practice Address - Country:US
Practice Address - Phone:206-362-3344
Practice Address - Fax:206-362-3444
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034743111N00000X
OR23980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0250083OtherLNI
WA0250083OtherLNI