Provider Demographics
NPI:1023438124
Name:MARTIN, JARRAD ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:JARRAD
Middle Name:ANTHONY
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 1:4011 W PLANO PKWY
Mailing Address - Street 2:STE 115
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5629
Mailing Address - Country:US
Mailing Address - Phone:972-900-3600
Mailing Address - Fax:
Practice Address - Street 1:4011 W PLANO PKWY
Practice Address - Street 2:STE 115
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5629
Practice Address - Country:US
Practice Address - Phone:972-900-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor