Provider Demographics
NPI:1700999075
Name:MARTIN, CAROLE A (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HIGHWAY 17 N
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BCH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6029
Mailing Address - Country:US
Mailing Address - Phone:843-238-5900
Mailing Address - Fax:843-238-5910
Practice Address - Street 1:400 HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:SURFSIDE BCH
Practice Address - State:SC
Practice Address - Zip Code:29575-6029
Practice Address - Country:US
Practice Address - Phone:843-238-5900
Practice Address - Fax:843-238-5910
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC201076267OtherTAX ID#
SCCH2253Medicaid
SC86789Medicare UPIN
SCCH2253Medicaid