Healthcare Provider Details

I. General information

NPI: 1558618637
Provider Name (Legal Business Name): MARISOL MARTINEZ, D.C., CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 EL MOLINO AVE
ALTADENA CA
91001-2318
US

IV. Provider business mailing address

2526 EL MOLINO AVE
ALTADENA CA
91001-2318
US

V. Phone/Fax

Practice location:
  • Phone: 626-791-8586
  • Fax:
Mailing address:
  • Phone: 626-791-8586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29576
License Number StateCA

VIII. Authorized Official

Name: DR. MARISOL MARTINEZ
Title or Position: PRESIDENT/ OWNER/ CHIROPRACTOR
Credential: D.C.
Phone: 626-791-8586