Provider Demographics
NPI:1295168714
Name:MARTIN, LAUREN E (DC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:MANDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6825 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-1841
Mailing Address - Country:US
Mailing Address - Phone:409-744-2225
Mailing Address - Fax:
Practice Address - Street 1:6825 STEWART RD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-1841
Practice Address - Country:US
Practice Address - Phone:409-744-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
12666069OtherCAQH
TX8EC958OtherBLUECROSS BLUESHIELD