Provider Demographics
NPI:1205910247
Name:MARTENS CHIROPRACTIC AND ACUPUNCTURE CENTER, S.C.
Entity type:Organization
Organization Name:MARTENS CHIROPRACTIC AND ACUPUNCTURE CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-985-7700
Mailing Address - Street 1:7511 LEMONT RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4394
Mailing Address - Country:US
Mailing Address - Phone:630-985-7700
Mailing Address - Fax:630-985-7800
Practice Address - Street 1:7511 LEMONT RD
Practice Address - Street 2:SUITE 150
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-4394
Practice Address - Country:US
Practice Address - Phone:630-985-7700
Practice Address - Fax:630-985-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232917OtherBCBS NUMBER
ILU94800Medicare UPIN
IL214149Medicare ID - Type Unspecified