Provider Demographics
NPI:1609096700
Name:MARTIN, JANELLE GAIL (DC)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:GAIL
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 1:4974 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4616
Mailing Address - Country:US
Mailing Address - Phone:716-625-9066
Mailing Address - Fax:716-625-9022
Practice Address - Street 1:4974 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4616
Practice Address - Country:US
Practice Address - Phone:716-625-9066
Practice Address - Fax:716-625-9022
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor