Provider Demographics
NPI:1629143631
Name:MARTIN, HOWARD SAMUEL (DC)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:SAMUEL
Last Name:MARTIN
Suffix:
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 1:2128 FERRELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3227
Mailing Address - Country:US
Mailing Address - Phone:805-772-2201
Mailing Address - Fax:
Practice Address - Street 1:2128 FERRELL AVE
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3227
Practice Address - Country:US
Practice Address - Phone:805-772-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU90991Medicare UPIN