Provider Demographics
NPI:1659550531
Name:GARY S MARTIN PC
Entity Type:Organization
Organization Name:GARY S MARTIN PC
Other - Org Name:DULUTH CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-623-9291
Mailing Address - Street 1:3499 DULUTH PARK LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5714
Mailing Address - Country:US
Mailing Address - Phone:770-623-9291
Mailing Address - Fax:770-623-1308
Practice Address - Street 1:3499 DULUTH PARK LN
Practice Address - Street 2:SUITE 110
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5714
Practice Address - Country:US
Practice Address - Phone:770-623-9291
Practice Address - Fax:770-623-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1174579841OtherMEDICARE PTAN 35ZCBFB