Provider Demographics
NPI:1841303229
Name:MARTIN CHIROPRACTIC
Entity type:Organization
Organization Name:MARTIN CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-591-2525
Mailing Address - Street 1:13801 ROSWELL AVE STE F
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5466
Mailing Address - Country:US
Mailing Address - Phone:909-591-2525
Mailing Address - Fax:909-464-9797
Practice Address - Street 1:13801 ROSWELL AVE STE F
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5466
Practice Address - Country:US
Practice Address - Phone:909-591-2525
Practice Address - Fax:909-464-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty