Provider Demographics
NPI:1902829906
Name:STONE, MARTIN SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:SCOTT
Last Name:STONE
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 1:1171 MARKET ST STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6502
Mailing Address - Country:US
Mailing Address - Phone:803-493-7544
Mailing Address - Fax:803-802-2413
Practice Address - Street 1:1171 MARKET ST STE 104
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6502
Practice Address - Country:US
Practice Address - Phone:803-493-7544
Practice Address - Fax:803-802-2413
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU641460281Medicare UPIN
SCU641460281Medicare PIN