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General NPI Number Information
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NPI Number | 1215587233
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Entity Type | Organization
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Legal Business Name | JACK K MARTIN DC PLLC
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 12900 S US HIGHWAY 27 STE 1A
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City | DEWITT
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State | MI
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Zip | 48820-8340
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Country | US
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Telephone | 517-668-6750
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Fax |
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Provider Business Mailing Address
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Address Line | 12900 S US HIGHWAY 27 STE 1A
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City | DEWITT
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State | MI
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Zip | 48820-8340
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Country | US
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Telephone | 517-668-6750
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Fax | 517-668-6751
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JACK K MARTIN
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Credential | DC
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Telephone | 517-668-6750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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