Provider Demographics
NPI:1679601173
Name:ARGALL, MARTIN WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:WAYNE
Last Name:ARGALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 SHASTA WAY
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4841
Mailing Address - Country:US
Mailing Address - Phone:541-883-1240
Mailing Address - Fax:541-883-1240
Practice Address - Street 1:4245 SHASTA WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4841
Practice Address - Country:US
Practice Address - Phone:541-883-1240
Practice Address - Fax:541-883-1240
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR012760Medicaid
ORR0000QGHCFMedicare ID - Type Unspecified
OR012760Medicaid