Provider Demographics
NPI:1548570047
Name:MARTINEZ, MATTHEW WALTER (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WALTER
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 1:2401 BRISTOL CT SW
Mailing Address - Street 2:SUITE A-102
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6003
Mailing Address - Country:US
Mailing Address - Phone:360-350-0539
Mailing Address - Fax:360-539-7336
Practice Address - Street 1:2401 BRISTOL CT SW
Practice Address - Street 2:SUITE A-102
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6003
Practice Address - Country:US
Practice Address - Phone:360-350-0539
Practice Address - Fax:360-539-7336
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60191433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor