Healthcare Provider Details

I. General information

NPI: 1629325824
Provider Name (Legal Business Name): PIA MARTIN CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 CARINGA WAY # 48
CARLSBAD CA
92009-6374
US

IV. Provider business mailing address

11622 EL CAMINO REAL STE. 100
SAN DIEGO CA
92130-2049
US

V. Phone/Fax

Practice location:
  • Phone: 214-869-6404
  • Fax:
Mailing address:
  • Phone: 214-869-6404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number30743
License Number StateCA

VIII. Authorized Official

Name: DR. PIA MARTIN
Title or Position: CEO
Credential: DC
Phone: 214-869-6404