Provider Demographics
NPI:1619040144
Name:MARTIN, DAVID RICHARD (BSC, DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:BSC, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4220
Mailing Address - Country:US
Mailing Address - Phone:352-732-2745
Mailing Address - Fax:352-732-8066
Practice Address - Street 1:1007 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4220
Practice Address - Country:US
Practice Address - Phone:352-732-2745
Practice Address - Fax:352-732-8066
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9106111N00000X
GACHIR006551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64018OtherCHIROPRACTIC
FL64018AMedicare ID - Type UnspecifiedCHIROPRACTIC
FLU79608Medicare UPIN