Provider Demographics
NPI:1689973596
Name:CALLAN A MARTIN DC PLLC
Entity Type:Organization
Organization Name:CALLAN A MARTIN DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CALLAN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-442-3444
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:EXMORE
Mailing Address - State:VA
Mailing Address - Zip Code:23350-0641
Mailing Address - Country:US
Mailing Address - Phone:757-442-3444
Mailing Address - Fax:757-442-4913
Practice Address - Street 1:15399 MERRY CAT LN
Practice Address - Street 2:
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306
Practice Address - Country:US
Practice Address - Phone:757-442-3444
Practice Address - Fax:757-442-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20110381261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center