Provider Demographics
NPI:1720453848
Name:MARTENS, CHAD
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:MARTENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13242
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66282-3242
Mailing Address - Country:US
Mailing Address - Phone:816-444-1218
Mailing Address - Fax:
Practice Address - Street 1:404 E BANNISTER RD STE B
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-3020
Practice Address - Country:US
Practice Address - Phone:816-444-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05416111N00000X
MO2008008295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor