Provider Demographics
NPI:1598229486
Name:MARTIN, TARRAH (DC)
Entity Type:Individual
Prefix:
First Name:TARRAH
Middle Name:
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 1:1796 W CARO RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9287
Mailing Address - Country:US
Mailing Address - Phone:989-672-1095
Mailing Address - Fax:989-672-1098
Practice Address - Street 1:1796 W CARO RD STE 1
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9287
Practice Address - Country:US
Practice Address - Phone:989-672-1095
Practice Address - Fax:989-672-1098
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05929111N00000X
MI2301010774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty