Provider Demographics
NPI:1861828550
Name:MARTINEZ, JEROME E (DC)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:E
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 1:1135 GEORGETOWN ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BART
Mailing Address - State:PA
Mailing Address - Zip Code:17503-9999
Mailing Address - Country:US
Mailing Address - Phone:717-786-4792
Mailing Address - Fax:717-786-4794
Practice Address - Street 1:1135 GEORGETOWN ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:BART
Practice Address - State:PA
Practice Address - Zip Code:17503-9999
Practice Address - Country:US
Practice Address - Phone:717-786-4792
Practice Address - Fax:717-786-4794
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor