Healthcare Provider Details

I. General information

NPI: 1144552878
Provider Name (Legal Business Name): HEATHER ANN MARTIN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER ANN DILLON D.C.

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 12/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 HIGHWAY 45 BYP S
MEDINA TN
38355-9629
US

IV. Provider business mailing address

611 HIGHWAY 45 BYP S
MEDINA TN
38355-9629
US

V. Phone/Fax

Practice location:
  • Phone: 731-783-0602
  • Fax: 731-783-0604
Mailing address:
  • Phone: 731-783-0602
  • Fax: 731-783-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2406
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: