Provider Demographics
NPI:1518024223
Name:GEOFFREYS, MARTIN D (DC, CCSP)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:D
Last Name:GEOFFREYS
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24863 DEL PRADO
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629
Mailing Address - Country:US
Mailing Address - Phone:949-248-1314
Mailing Address - Fax:949-248-1335
Practice Address - Street 1:24863 DEL PRADO
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629
Practice Address - Country:US
Practice Address - Phone:949-248-1314
Practice Address - Fax:949-248-1335
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23040111NS0005X
CA23040111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC23040Medicare PIN