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General NPI Number Information
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NPI Number | 1295139160
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Entity Type | Organization
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Legal Business Name | PETER MARTIN CHIROPRACTIC PC
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 10710 SHORE FRONT PKWY STE 200
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2637
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Country | US
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Telephone | 347-926-4221
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Fax |
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Provider Business Mailing Address
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Address Line | 10710 SHORE FRONT PKWY STE 200
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2637
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Country | US
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Telephone | 347-926-4221
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER MARTIN DC
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Credential | D.C.
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Telephone | 347-926-4221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number | X007467-1
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License Number State | NY
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