Provider Demographics
NPI:1669472353
Name:MARTINEZ, JOHN BARTLEY (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BARTLEY
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SOUTH STREET (BLAIR HOUSE)
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7700
Mailing Address - Country:US
Mailing Address - Phone:973-455-1660
Mailing Address - Fax:973-455-1660
Practice Address - Street 1:230 SOUTH STREET (BLAIR HOUSE)
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7700
Practice Address - Country:US
Practice Address - Phone:973-455-1660
Practice Address - Fax:973-455-0084
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00268000111NX0800X, 111N00000X
NJ25MZ00123800171100000X
MA813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ509052Medicare ID - Type Unspecified
NJ088627Medicare ID - Type Unspecified
NJU17300Medicare UPIN