Provider Demographics
NPI:1740581735
Name:MARTIN, WILLIAM BROCK (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BROCK
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 1:159 COURT SQ
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-3709
Mailing Address - Country:US
Mailing Address - Phone:731-535-3205
Mailing Address - Fax:731-535-3203
Practice Address - Street 1:159 COURT SQ
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-3709
Practice Address - Country:US
Practice Address - Phone:731-535-3205
Practice Address - Fax:731-535-3203
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN003247OtherRAILROAD MEDICARE PALMETTO GBA
TN1512419Medicaid
TN1104017003Medicare PIN
TN003247OtherRAILROAD MEDICARE PALMETTO GBA