Healthcare Provider Details

I. General information

NPI: 1801805866
Provider Name (Legal Business Name): CHARLES JONATHAN MARTIN D.C., D.A.C.A.N
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 CARMELITO AVE
MONTEREY CA
93940-4521
US

IV. Provider business mailing address

142 CARMELITO AVE
MONTEREY CA
93940-4521
US

V. Phone/Fax

Practice location:
  • Phone: 831-373-7756
  • Fax: 831-373-7760
Mailing address:
  • Phone: 831-373-7756
  • Fax: 831-373-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCA11975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: