Provider Demographics
NPI:1770569923
Name:MARTIN, KEITH BLAINE (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:BLAINE
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 1:285 NE MIDWAY BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2699
Mailing Address - Country:US
Mailing Address - Phone:360-672-9898
Mailing Address - Fax:844-389-4333
Practice Address - Street 1:285 NE MIDWAY BLVD STE 7
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2699
Practice Address - Country:US
Practice Address - Phone:360-672-9898
Practice Address - Fax:844-389-4333
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3047111N00000X
WACH00034846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6757MAOtherREGENCE BLUE SHIELD
WA0226757OtherWASHINGTON L & I
WA2034031Medicaid
MET54472Medicare UPIN
WA6757MAOtherREGENCE BLUE SHIELD
WA0226757OtherWASHINGTON L & I