Provider Demographics
NPI:1023232394
Name:MARTIN, STEPHANIE (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 CHERRY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-1704
Mailing Address - Country:US
Mailing Address - Phone:925-408-5936
Mailing Address - Fax:925-674-9222
Practice Address - Street 1:2350 MONUMENT BOULEVARD
Practice Address - Street 2:SUITE C
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3954
Practice Address - Country:US
Practice Address - Phone:925-676-8200
Practice Address - Fax:925-674-9222
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0301810Medicare PIN