Provider Demographics
NPI:1891090767
Name:MARTINDALE, JUSTIN B (DC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:B
Last Name:MARTINDALE
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 1:110 N PEORIA ST
Mailing Address - Street 2:UNIT 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2396
Mailing Address - Country:US
Mailing Address - Phone:847-774-8733
Mailing Address - Fax:312-690-4880
Practice Address - Street 1:110 N PEORIA ST
Practice Address - Street 2:UNIT 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2396
Practice Address - Country:US
Practice Address - Phone:847-774-8733
Practice Address - Fax:312-690-4880
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor