Provider Demographics
NPI:1508833492
Name:MARTINEZ, DAMIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:
Last Name:MARTINEZ
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 1:12595 SW 137TH AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4220
Mailing Address - Country:US
Mailing Address - Phone:305-388-7577
Mailing Address - Fax:305-388-7851
Practice Address - Street 1:12595 SW 137TH AVE
Practice Address - Street 2:STE 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4220
Practice Address - Country:US
Practice Address - Phone:305-388-7577
Practice Address - Fax:305-388-7851
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380061000Medicaid
FL22728Medicare ID - Type Unspecified
FL380061000Medicaid