Provider Demographics
NPI:1942488010
Name:DR THOMAS R MARTIN PC
Entity Type:Organization
Organization Name:DR THOMAS R MARTIN PC
Other - Org Name:PEORIA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-412-0412
Mailing Address - Street 1:7966 W THUNDERBIRD RD
Mailing Address - Street 2:# 102
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4902
Mailing Address - Country:US
Mailing Address - Phone:623-412-0412
Mailing Address - Fax:623-487-3339
Practice Address - Street 1:7966 W THUNDERBIRD RD
Practice Address - Street 2:# 102
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4902
Practice Address - Country:US
Practice Address - Phone:623-412-0412
Practice Address - Fax:623-487-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ79078Medicare PIN