Provider Demographics
NPI:1477693398
Name:EDWARD L MARTIN PC
Entity Type:Organization
Organization Name:EDWARD L MARTIN PC
Other - Org Name:MARTIN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-777-8282
Mailing Address - Street 1:5905 W ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48722-9656
Mailing Address - Country:US
Mailing Address - Phone:989-777-8282
Mailing Address - Fax:989-777-8680
Practice Address - Street 1:5905 W ROLLING HILLS DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9656
Practice Address - Country:US
Practice Address - Phone:989-777-8282
Practice Address - Fax:989-777-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G31168OtherBLUE CROSS BLUE SHIELD
MI0G31168OtherBLUE CROSS BLUE SHIELD
MI6016420001Medicare NSC
MI0P08000Medicare PIN