Provider Demographics
NPI:1912661471
Name:MARTINEZ, KRYSTLE (DC)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 PARK LN APT 3
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-8500
Mailing Address - Country:US
Mailing Address - Phone:561-685-1950
Mailing Address - Fax:
Practice Address - Street 1:9325 GLADES RD STE 104
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3988
Practice Address - Country:US
Practice Address - Phone:561-513-8380
Practice Address - Fax:561-423-7657
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor