Provider Demographics
NPI:1639409261
Name:MARTIN, BRETT R (D C)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E MAIN ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2387
Mailing Address - Country:US
Mailing Address - Phone:630-377-4955
Mailing Address - Fax:630-377-4958
Practice Address - Street 1:1601 E MAIN ST STE 1B
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2387
Practice Address - Country:US
Practice Address - Phone:630-377-4955
Practice Address - Fax:630-377-4958
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-011586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor