Provider Demographics
NPI:1437282647
Name:MARTIN, KRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:
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 1:3540 S POPLAR ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1360
Mailing Address - Country:US
Mailing Address - Phone:303-691-9970
Mailing Address - Fax:
Practice Address - Street 1:3540 S POPLAR ST
Practice Address - Street 2:SUITE 306
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1360
Practice Address - Country:US
Practice Address - Phone:303-691-9970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7612111N00000X, 111NN1001X
COCHR-6494111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0155500OtherBLUECROSS
AZAZ0155500OtherBLUECROSS