Provider Demographics
NPI:1295139160
Name:PETER MARTIN CHIROPRACTIC PC
Entity type:Organization
Organization Name:PETER MARTIN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:DC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:347-926-4221
Mailing Address - Street 1:10710 SHORE FRONT PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2637
Mailing Address - Country:US
Mailing Address - Phone:347-926-4221
Mailing Address - Fax:
Practice Address - Street 1:10710 SHORE FRONT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2637
Practice Address - Country:US
Practice Address - Phone:347-926-4221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER MARTIN CHIROPRACTIC, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-21
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007467-1111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009101Medicare UPIN