Provider Demographics
NPI:1558618637
Name:MARISOL MARTINEZ, D.C., CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:MARISOL MARTINEZ, D.C., CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-791-8586
Mailing Address - Street 1:2526 EL MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2318
Mailing Address - Country:US
Mailing Address - Phone:626-791-8586
Mailing Address - Fax:
Practice Address - Street 1:2526 EL MOLINO AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2318
Practice Address - Country:US
Practice Address - Phone:626-791-8586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty