Provider Demographics
NPI:1467227694
Name:MARTINEZ, KYARA (DC)
Entity Type:Individual
Prefix:
First Name:KYARA
Middle Name:
Last Name:MARTINEZ
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 1:9040 CAMBER LN APT 4112
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-1250
Mailing Address - Country:US
Mailing Address - Phone:787-391-0353
Mailing Address - Fax:
Practice Address - Street 1:2686 OLD ALTON RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-7005
Practice Address - Country:US
Practice Address - Phone:940-323-9910
Practice Address - Fax:214-241-4667
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor