Provider Demographics
NPI:1467576884
Name:MARTIN, DEREK ABEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ABEL
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 1:13843 HWY 105 WEST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304
Mailing Address - Country:US
Mailing Address - Phone:936-447-5959
Mailing Address - Fax:936-588-4911
Practice Address - Street 1:13843 HWY 105 WEST
Practice Address - Street 2:SUITE 105
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-447-5959
Practice Address - Fax:936-588-4911
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609084Medicare ID - Type Unspecified
U59555Medicare UPIN