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General NPI Number Information
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NPI Number | 1033110366
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Entity Type | Individual
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Provider Name | NICOLAS C MARTINEZ D.C, F.A.C.O
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3720 W 26TH ST 2ND FL.
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City | CHICAGO
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State | IL
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Zip | 60623-3824
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Country | US
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Telephone | 773-277-2225
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Fax | 773-277-1134
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Provider Business Mailing Address
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Address Line | 651 W ARMITAGE AVE
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City | ELMHURST
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State | IL
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Zip | 60126-2122
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Country | US
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Telephone | 630-833-4725
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Fax | 630-833-6756
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number |
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License Number State | IL
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