Provider Demographics
NPI:1801369426
Name:MARTINEZ, CRISTOBAL ANTONIO (DC)
Entity Type:Individual
Prefix:DR
First Name:CRISTOBAL
Middle Name:ANTONIO
Last Name:MARTINEZ
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 1:5820 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8283
Mailing Address - Country:US
Mailing Address - Phone:716-410-5566
Mailing Address - Fax:
Practice Address - Street 1:5820 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8283
Practice Address - Country:US
Practice Address - Phone:716-410-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor