Healthcare Provider Details

I. General information

NPI: 1104884675
Provider Name (Legal Business Name): TIMOTHY F MARTIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E CEDAR AVE SUITE 80
FLAGSTAFF AZ
86004
US

IV. Provider business mailing address

2525 W CAREFREE HWY BLD 1 SUITE 100
PHOENIX AZ
85085
US

V. Phone/Fax

Practice location:
  • Phone: 928-522-8459
  • Fax: 928-522-8462
Mailing address:
  • Phone: 623-587-0277
  • Fax: 623-587-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5518
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: