Provider Demographics
NPI:1457510992
Name:MARTIN, DIRK CHARLES JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:CHARLES
Last Name:MARTIN
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 1:206 W NOLANA ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2513
Mailing Address - Country:US
Mailing Address - Phone:956-682-7351
Mailing Address - Fax:956-630-1033
Practice Address - Street 1:206 W NOLANA ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2513
Practice Address - Country:US
Practice Address - Phone:956-682-7351
Practice Address - Fax:956-630-1033
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A6036Medicare UPIN