Provider Demographics
NPI:1750389656
Name:MARTI, MATTHEW D (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:MARTI
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 1:902 POLK ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-1926
Mailing Address - Country:US
Mailing Address - Phone:815-672-2176
Mailing Address - Fax:815-672-2177
Practice Address - Street 1:2126 N BLOOMINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-1394
Practice Address - Country:US
Practice Address - Phone:815-672-2176
Practice Address - Fax:815-672-2177
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU75410Medicare UPIN
IL350052987Medicare ID - Type UnspecifiedRAILROAD MEDICARE