Provider Demographics
NPI:1790918233
Name:LANDRY, DAVID MARTIN II (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARTIN
Last Name:LANDRY
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5096 CASTLE CT
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-1460
Mailing Address - Country:US
Mailing Address - Phone:951-897-2810
Mailing Address - Fax:
Practice Address - Street 1:3576 ARLINGTON AVE STE 211
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3986
Practice Address - Country:US
Practice Address - Phone:951-405-8868
Practice Address - Fax:951-742-4704
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor