Provider Demographics
NPI:1467615369
Name:MARTIS CHIROPRACTIC
Entity Type:Organization
Organization Name:MARTIS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARRI
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-347-1500
Mailing Address - Street 1:1340 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-5082
Mailing Address - Country:US
Mailing Address - Phone:309-347-1500
Mailing Address - Fax:309-347-1510
Practice Address - Street 1:1340 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-5082
Practice Address - Country:US
Practice Address - Phone:309-347-1500
Practice Address - Fax:309-347-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004275111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9082010OtherBLUE CROSS BLUE SHIELD
9082010OtherBLUE CROSS BLUE SHIELD