Provider Demographics
NPI:1467897603
Name:MARTINEZ FELICIANO, GRETCHEN (DC)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:MARTINEZ FELICIANO
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 1:221 N LA SALLE ST
Mailing Address - Street 2:SUITE 1740
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:787-460-9563
Mailing Address - Fax:
Practice Address - Street 1:221 N LA SALLE ST
Practice Address - Street 2:SUITE 1740
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:787-460-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor