Provider Demographics
NPI:1760960330
Name:MARTIN, CHELSEA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:MARIE
Last Name:MARTIN
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 1:4562 KINGS CROSSING DR NE
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1673
Mailing Address - Country:US
Mailing Address - Phone:205-399-6302
Mailing Address - Fax:
Practice Address - Street 1:4425 S COBB DR SE STE G
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6369
Practice Address - Country:US
Practice Address - Phone:770-444-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor