Healthcare Provider Details

I. General information

NPI: 1669472353
Provider Name (Legal Business Name): JOHN BARTLEY MARTINEZ DC, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 SOUTH STREET (BLAIR HOUSE)
MORRISTOWN NJ
07960-7700
US

IV. Provider business mailing address

230 SOUTH STREET (BLAIR HOUSE)
MORRISTOWN NJ
07960-7700
US

V. Phone/Fax

Practice location:
  • Phone: 973-455-1660
  • Fax: 973-455-0084
Mailing address:
  • Phone: 973-455-1660
  • Fax: 973-455-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number38MC00268000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00268000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00123800
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: