Provider Demographics
NPI:1780629972
Name:ANDRIES, MARTIN T (DC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:T
Last Name:ANDRIES
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 1:316 W PANOLA ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-2535
Mailing Address - Country:US
Mailing Address - Phone:903-693-8338
Mailing Address - Fax:903-693-2383
Practice Address - Street 1:316 W PANOLA ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-2535
Practice Address - Country:US
Practice Address - Phone:903-693-8338
Practice Address - Fax:903-693-2383
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT86132Medicare UPIN
TX603669Medicare ID - Type Unspecified