Provider Demographics
NPI:1447225693
Name:MARTENS, KATHLEEN A (DC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:MARTENS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 LEMONT RD
Mailing Address - Street 2:SUITE 345
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2653
Mailing Address - Country:US
Mailing Address - Phone:630-985-7700
Mailing Address - Fax:630-910-1079
Practice Address - Street 1:7501 LEMONT RD
Practice Address - Street 2:SUITE 345
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2653
Practice Address - Country:US
Practice Address - Phone:630-985-7700
Practice Address - Fax:630-910-1079
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214149Medicare PIN