Provider Demographics
NPI:1528189537
Name:J MARTINEZ CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:J MARTINEZ CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-843-8160
Mailing Address - Street 1:137 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-3702
Mailing Address - Country:US
Mailing Address - Phone:708-343-8160
Mailing Address - Fax:708-343-4956
Practice Address - Street 1:137 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3702
Practice Address - Country:US
Practice Address - Phone:708-343-8160
Practice Address - Fax:708-343-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty