Provider Demographics
NPI:1811196603
Name:YABLONOVSKY, MARTIN (DC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:YABLONOVSKY
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 1:6211B PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:CA
Mailing Address - Zip Code:95623-4232
Mailing Address - Country:US
Mailing Address - Phone:530-622-7600
Mailing Address - Fax:
Practice Address - Street 1:6211B PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:CA
Practice Address - Zip Code:95623-4232
Practice Address - Country:US
Practice Address - Phone:530-622-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04173Medicare UPIN