Provider Demographics
NPI:1295742427
Name:HABERN, MARTIN GARWOOD (DC)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GARWOOD
Last Name:HABERN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2473
Mailing Address - Country:US
Mailing Address - Phone:626-914-5315
Mailing Address - Fax:626-914-5315
Practice Address - Street 1:826 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2509
Practice Address - Country:US
Practice Address - Phone:626-334-3075
Practice Address - Fax:626-969-3911
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor