Provider Demographics
NPI:1629397658
Name:MARTINEZ, STEVE MICHAEL (LAC)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:MICHAEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 2ND ST E
Mailing Address - Street 2:SUITE #225
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6110
Mailing Address - Country:US
Mailing Address - Phone:406-270-1655
Mailing Address - Fax:
Practice Address - Street 1:40 2ND ST E
Practice Address - Street 2:SUITE #225
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6110
Practice Address - Country:US
Practice Address - Phone:406-270-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT208463135171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist