Provider Demographics
NPI:1811072903
Name:MARTI, ELISABETH (DC)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:
Last Name:MARTI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:HICKOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4112 HARBOR HILLS RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-1703
Mailing Address - Country:US
Mailing Address - Phone:423-413-5053
Mailing Address - Fax:
Practice Address - Street 1:4112 HARBOR HILLS RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-1703
Practice Address - Country:US
Practice Address - Phone:423-413-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2089111N00000X
GA7947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNV11578Medicare UPIN
TN3974126Medicare ID - Type Unspecified