Healthcare Provider Details

I. General information

NPI: 1447089081
Provider Name (Legal Business Name): MASON MARTIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21732 LORAIN RD
FAIRVIEW PARK OH
44126-3329
US

IV. Provider business mailing address

22250 MASTICK RD
FAIRVIEW PARK OH
44126-3158
US

V. Phone/Fax

Practice location:
  • Phone: 440-413-7311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-05380
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: