Provider Demographics
NPI:1255640827
Name:TERRY H MARTIN, D.C.P.C.
Entity type:Organization
Organization Name:TERRY H MARTIN, D.C.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-969-8197
Mailing Address - Street 1:1951 W 4700 S
Mailing Address - Street 2:SUITE1
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-1108
Mailing Address - Country:US
Mailing Address - Phone:801-969-8197
Mailing Address - Fax:801-969-8192
Practice Address - Street 1:1951 W 4700 S
Practice Address - Street 2:SUITE 1
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-1108
Practice Address - Country:US
Practice Address - Phone:801-969-8197
Practice Address - Fax:801-969-8192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT161807-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529823124013Medicaid
UTU000005653Medicare PIN
UT529823124013Medicaid