Provider Demographics
NPI:1851481451
Name:MARTIN, JOSEPH ADAM JR (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ADAM
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:J.
Other - Middle Name:ADAM
Other - Last Name:MARTIN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:512 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-4915
Mailing Address - Country:US
Mailing Address - Phone:662-534-6330
Mailing Address - Fax:662-534-7418
Practice Address - Street 1:512 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-4915
Practice Address - Country:US
Practice Address - Phone:662-534-6330
Practice Address - Fax:662-534-7418
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115905Medicaid
MS00115905Medicaid