Healthcare Provider Details

I. General information

NPI: 1073877056
Provider Name (Legal Business Name): DANIEL A MARTINEZ D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2618 ELECTRONIC LN SUITE 102
DALLAS TX
75220-1216
US

IV. Provider business mailing address

2205 ANITA DR
MESQUITE TX
75149-1332
US

V. Phone/Fax

Practice location:
  • Phone: 214-385-9881
  • Fax:
Mailing address:
  • Phone: 214-385-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number10599
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: