Provider Demographics
NPI:1629106745
Name:MUNLEY, MARTIN THOMAS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:THOMAS
Last Name:MUNLEY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 BIRNEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1516
Mailing Address - Country:US
Mailing Address - Phone:570-963-1033
Mailing Address - Fax:570-558-1709
Practice Address - Street 1:3910 BIRNEY AVENUE
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1516
Practice Address - Country:US
Practice Address - Phone:570-963-1033
Practice Address - Fax:570-558-1709
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004806L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01661110Medicaid
PAMU757656OtherBC
PAMU1670025OtherBCBS
57111Medicare UPIN
PA57111Medicare ID - Type Unspecified