Provider Demographics
NPI:1679544993
Name:MARTINEZ, PHILIP R (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:PHILIP
Other - Middle Name:R
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2507 SW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-6613
Mailing Address - Country:US
Mailing Address - Phone:405-686-1309
Mailing Address - Fax:405-686-1311
Practice Address - Street 1:2507 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-6613
Practice Address - Country:US
Practice Address - Phone:405-686-1309
Practice Address - Fax:405-686-1311
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor