Healthcare Provider Details

I. General information

NPI: 1447225693
Provider Name (Legal Business Name): KATHLEEN A MARTENS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 LEMONT RD SUITE 345
WOODRIDGE IL
60517-2653
US

IV. Provider business mailing address

7501 LEMONT RD SUITE 345
WOODRIDGE IL
60517-2653
US

V. Phone/Fax

Practice location:
  • Phone: 630-985-7700
  • Fax: 630-910-1079
Mailing address:
  • Phone: 630-985-7700
  • Fax: 630-910-1079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009832
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: