Provider Demographics
NPI:1801805866
Name:MARTIN, CHARLES JONATHAN (DC, DACAN)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JONATHAN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DC, DACAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 CARMELITO AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4521
Mailing Address - Country:US
Mailing Address - Phone:831-373-7756
Mailing Address - Fax:831-373-7760
Practice Address - Street 1:142 CARMELITO AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4521
Practice Address - Country:US
Practice Address - Phone:831-373-7756
Practice Address - Fax:831-373-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA11975111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
T04573Medicare UPIN
DC0119750Medicare ID - Type Unspecified