Provider Demographics
NPI:1518993690
Name:MARTIN, YVONNA BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:YVONNA
Middle Name:BETH
Last Name:MARTIN
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 1:1419 S DELSEA DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6253
Mailing Address - Country:US
Mailing Address - Phone:856-692-2521
Mailing Address - Fax:856-692-6434
Practice Address - Street 1:1419 S DELSEA DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6253
Practice Address - Country:US
Practice Address - Phone:856-692-2521
Practice Address - Fax:856-692-6434
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00503300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7219008Medicaid
NJ0452139000OtherAMERIHEALTH HMO ID
NJU65427Medicare UPIN
752429Medicare ID - Type Unspecified