Provider Demographics
NPI:1356308837
Name:GILDEA, MARTIN SEAN (DC)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:SEAN
Last Name:GILDEA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MARTIN
Other - Middle Name:S
Other - Last Name:GILDEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:400 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-3752
Mailing Address - Country:US
Mailing Address - Phone:941-421-4488
Mailing Address - Fax:717-486-3426
Practice Address - Street 1:400 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3752
Practice Address - Country:US
Practice Address - Phone:941-421-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004031L111N00000X
FLCH13406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02844500OtherBC
PA668764OtherHIGHMARK BS
668764Medicare ID - Type Unspecified
U16979Medicare UPIN