Provider Demographics
NPI:1750667689
Name:EISELE, MARTIN JR (LAC, JD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:EISELE
Suffix:JR
Gender:M
Credentials:LAC, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VAN CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5273
Mailing Address - Country:US
Mailing Address - Phone:501-663-3461
Mailing Address - Fax:
Practice Address - Street 1:2 VAN CIR STE 1
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5273
Practice Address - Country:US
Practice Address - Phone:501-663-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL.AC. 027171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist