Provider Demographics
NPI:1821414962
Name:GOUGH, MARTIN TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:TODD
Last Name:GOUGH
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 1:900 BOWMAN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3218
Mailing Address - Country:US
Mailing Address - Phone:843-972-0227
Mailing Address - Fax:
Practice Address - Street 1:900 BOWMAN RD STE 105
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3218
Practice Address - Country:US
Practice Address - Phone:843-972-0227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1977111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic