Provider Demographics
NPI:1558305037
Name:MARTIN, CLEM C (DC)
Entity type:Individual
Prefix:DR
First Name:CLEM
Middle Name:C
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 1:2110 N CENTER ST STE A
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-2628
Mailing Address - Country:US
Mailing Address - Phone:903-583-7574
Mailing Address - Fax:903-640-2067
Practice Address - Street 1:2110 N CENTER ST STE A
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2628
Practice Address - Country:US
Practice Address - Phone:903-583-7574
Practice Address - Fax:903-640-2067
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2052111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00967449OtherMEDICARE RAILROAD CARRIER
TX0068EVOtherBCBS
TX8A4830OtherBCBS NUMBER
TX8114624OtherBLUE LIKE NUMBER
TX8A4830OtherBCBS NUMBER
TXP00967449OtherMEDICARE RAILROAD CARRIER
TX00949ZMedicare ID - Type UnspecifiedMEDICARE NUMBER