Provider Demographics
NPI:1720043532
Name:DEMARTINO, BRUCE J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:DEMARTINO
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 1:4550 E. BELL ROAD
Mailing Address - Street 2:# 114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-9342
Mailing Address - Country:US
Mailing Address - Phone:602-996-6668
Mailing Address - Fax:602-494-0926
Practice Address - Street 1:4550 E. BELL ROAD
Practice Address - Street 2:# 114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9342
Practice Address - Country:US
Practice Address - Phone:602-996-6668
Practice Address - Fax:602-494-0926
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0932620OtherBCBS
AZ23073491OtherSTATE COMP
AZ347056OtherAHCCS
AZAZ0932620OtherBCBS
AZT8830Medicare UPIN