=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184923005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YVONNA BETH MARTIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2011
-----------------------------------------------------
Last Update Date | 04/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1419 S DELSEA DR
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-6253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-692-2521
-----------------------------------------------------
Fax | 856-692-6434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1419 S DELSEA DR
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-6253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-692-2521
-----------------------------------------------------
Fax | 856-692-6434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. YVONNA BETH MARTIN
-----------------------------------------------------
Credential | D.C,
-----------------------------------------------------
Telephone | 856-692-2521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00503300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------