Provider Demographics
NPI:1972890291
Name:MARTIN, CHASE MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:MATTHEW
Last Name:MARTIN
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:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:ST BONIFACIUS
Mailing Address - State:MN
Mailing Address - Zip Code:55375-1144
Mailing Address - Country:US
Mailing Address - Phone:952-446-1800
Mailing Address - Fax:952-446-1801
Practice Address - Street 1:4080 TOWER ST STE 1080
Practice Address - Street 2:
Practice Address - City:ST BONIFACIUS
Practice Address - State:MN
Practice Address - Zip Code:55375-1144
Practice Address - Country:US
Practice Address - Phone:952-446-1800
Practice Address - Fax:952-446-1801
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor