Provider Demographics
NPI:1710094974
Name:DECOURCY, MARTIN ST JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ST JOHN
Last Name:DECOURCY
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 1:10425 MARTY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-2569
Mailing Address - Country:US
Mailing Address - Phone:913-383-3031
Mailing Address - Fax:913-383-3041
Practice Address - Street 1:10425 MARTY ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-2569
Practice Address - Country:US
Practice Address - Phone:913-383-3031
Practice Address - Fax:913-383-3041
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
R470000Medicare ID - Type Unspecified