Provider Demographics
NPI:1659680940
Name:RAINVILLE, MARTHA R (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:R
Last Name:RAINVILLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-2205
Mailing Address - Country:US
Mailing Address - Phone:802-524-4600
Mailing Address - Fax:802-524-4700
Practice Address - Street 1:25 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-2205
Practice Address - Country:US
Practice Address - Phone:802-524-4600
Practice Address - Fax:802-524-4700
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VT006.0084296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0030413Medicare PIN