Healthcare Provider Details

I. General information

NPI: 1750389656
Provider Name (Legal Business Name): MATTHEW D MARTI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 N BLOOMINGTON ST SUITE 1
STREATOR IL
61364-1394
US

IV. Provider business mailing address

902 POLK ST
STREATOR IL
61364-1926
US

V. Phone/Fax

Practice location:
  • Phone: 815-672-2176
  • Fax: 815-672-2177
Mailing address:
  • Phone: 815-672-2176
  • Fax: 815-672-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008513
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: