Healthcare Provider Details

I. General information

NPI: 1073342564
Provider Name (Legal Business Name): ELIEZER MARTELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 E SR 44 STE 301
WILDWOOD FL
34785-7482
US

IV. Provider business mailing address

3990 E SR 44 STE 301
WILDWOOD FL
34785-7482
US

V. Phone/Fax

Practice location:
  • Phone: 407-889-3223
  • Fax: 407-889-7263
Mailing address:
  • Phone: 407-889-3223
  • Fax: 407-889-7263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: