Provider Demographics
NPI:1336267889
Name:MARTIN, GENE (DC)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402
Mailing Address - Country:US
Mailing Address - Phone:650-558-1010
Mailing Address - Fax:650-558-1019
Practice Address - Street 1:520 S EL CAMINO REAL
Practice Address - Street 2:SUITE 520
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-1726
Practice Address - Country:US
Practice Address - Phone:650-558-1010
Practice Address - Fax:650-558-1019
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17685111N00000X
NYX004889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0176850Medicare ID - Type UnspecifiedCHIROPRACTOR
CAU30878Medicare UPIN