Provider Demographics
NPI:1679632566
Name:DONALDSON, MARTIN STERLING (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:STERLING
Last Name:DONALDSON
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 1:1203 10TH ST S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4611
Mailing Address - Country:US
Mailing Address - Phone:208-467-6567
Mailing Address - Fax:208-467-5428
Practice Address - Street 1:1203 10TH ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4611
Practice Address - Country:US
Practice Address - Phone:208-467-6567
Practice Address - Fax:208-467-5428
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002718100Medicaid
ID002718100Medicaid