Healthcare Provider Details

I. General information

NPI: 1184900185
Provider Name (Legal Business Name): MARTIN FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2011
Last Update Date: 10/23/2011
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:
Mailing address:
  • Phone: 731-783-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. HEATHER A MARTIN
Title or Position: OWNER
Credential: D.C.
Phone: 731-783-0602