Provider Demographics
NPI:1770510950
Name:MARTIN, PATRICK WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WAYNE
Last Name:MARTIN
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 1:17323 IH 35 N
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1242
Mailing Address - Country:US
Mailing Address - Phone:210-646-6000
Mailing Address - Fax:210-651-0065
Practice Address - Street 1:17323 IH 35 N
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1242
Practice Address - Country:US
Practice Address - Phone:210-646-6000
Practice Address - Fax:210-651-0065
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608106OtherBLUECROSS AND BLUE SHEILD
TX608106OtherBLUECROSS AND BLUE SHEILD
TXU90696Medicare UPIN