Provider Demographics
NPI:1295277432
Name:BOOTH, MARTIN V JR (DC)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:V
Last Name:BOOTH
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:570 MEMORIAL CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5063
Mailing Address - Country:US
Mailing Address - Phone:386-236-9765
Mailing Address - Fax:386-777-2851
Practice Address - Street 1:570 MEMORIAL CIR STE 100
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5063
Practice Address - Country:US
Practice Address - Phone:386-236-9765
Practice Address - Fax:386-777-2851
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor