Provider Demographics
NPI:1982109401
Name:MARTINEZ JIMENEZ, CHRISTIAN MANUEL SR
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:MANUEL
Last Name:MARTINEZ JIMENEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8616 CALLEJON LOS GONZALEZ
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9732
Mailing Address - Country:US
Mailing Address - Phone:787-308-9713
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 110 KM 32
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-0998
Practice Address - Country:US
Practice Address - Phone:787-872-9988
Practice Address - Fax:787-877-3516
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor