Healthcare Provider Details

I. General information

NPI: 1912848987
Provider Name (Legal Business Name): BRYAN MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 W LAKE ST
MELROSE PARK IL
60160-3728
US

IV. Provider business mailing address

1908 W LAKE ST
MELROSE PARK IL
60160-3728
US

V. Phone/Fax

Practice location:
  • Phone: 312-241-0082
  • Fax:
Mailing address:
  • Phone: 312-241-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.014199
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: