Provider Demographics
NPI:1689156853
Name:MARTINEZ, SAVANNAH SIMONA (DC)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:SIMONA
Last Name:MARTINEZ
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 1:506 NE EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2025
Mailing Address - Country:US
Mailing Address - Phone:585-315-1067
Mailing Address - Fax:
Practice Address - Street 1:506 NE EVERETT ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2025
Practice Address - Country:US
Practice Address - Phone:585-315-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60883045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor