Provider Demographics
NPI:1992844500
Name:DIAN K. MARTENS D.C. INC.
Entity Type:Organization
Organization Name:DIAN K. MARTENS D.C. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIAN
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:MARTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-685-5486
Mailing Address - Street 1:321 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1638
Mailing Address - Country:US
Mailing Address - Phone:269-685-5486
Mailing Address - Fax:269-685-9711
Practice Address - Street 1:321 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1638
Practice Address - Country:US
Practice Address - Phone:269-685-5486
Practice Address - Fax:269-685-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3257741Medicaid
MIP93731OtherBLUE CARE NETWORK
MI10438AOtherHAP
MI4432056OtherPHP
MI950Z310550OtherBCBS
MIPRIORITYOtherPRIORITY
MIP93731OtherBLUE CARE NETWORK
MI0P43900Medicare PIN