Provider Demographics
NPI:1770594517
Name:MARTIN, MICHAEL C (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
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 1:1228 PRECINCT LINE RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4290
Mailing Address - Country:US
Mailing Address - Phone:817-282-5411
Mailing Address - Fax:817-282-5438
Practice Address - Street 1:1228 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4290
Practice Address - Country:US
Practice Address - Phone:817-282-5411
Practice Address - Fax:817-282-5438
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2992111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R9410OtherBLUE CROSS BLUE SHIELD
TX8D0193Medicare ID - Type Unspecified
TXT14620Medicare UPIN