Provider Demographics
NPI:1598036899
Name:TANYA MARTINEZ CHIROPRACTIC INC
Entity Type:Organization
Organization Name:TANYA MARTINEZ CHIROPRACTIC INC
Other - Org Name:CHIROPRACTIC HEALTHY LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-433-5041
Mailing Address - Street 1:550 PARKCENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3529
Mailing Address - Country:US
Mailing Address - Phone:714-313-0347
Mailing Address - Fax:714-953-4327
Practice Address - Street 1:550 PARKCENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3529
Practice Address - Country:US
Practice Address - Phone:714-313-0347
Practice Address - Fax:714-953-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC31936OtherLICENSE