Healthcare Provider Details

I. General information

NPI: 1871556654
Provider Name (Legal Business Name): BLAIR A MARTIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163-D BLUFFTON ROAD
BLUFFTON SC
29910
US

IV. Provider business mailing address

163-D BLUFFTON ROAD
BLUFFTON SC
29910
US

V. Phone/Fax

Practice location:
  • Phone: 843-757-4100
  • Fax: 843-757-6932
Mailing address:
  • Phone: 843-757-4100
  • Fax: 843-757-6932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberSC1846
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: