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General NPI Number Information
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NPI Number | 1306107818
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Entity Type | Individual
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Provider Name | JUAN MARTINEZ JR. DC
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Gender | Male
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Dates
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Enumeration Date | 05/31/2012
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 1999 N AMIDON AVE STE 224
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City | WICHITA
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State | KS
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Zip | 67203-2123
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Country | US
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Telephone | 316-838-8883
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Fax | 316-831-9233
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Provider Business Mailing Address
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Address Line | 1999 N AMIDON AVE STE 224
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City | WICHITA
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State | KS
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Zip | 67203-2123
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Country | US
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Telephone | 316-838-8883
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Fax | 316-831-9233
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 01-05475
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License Number State | KS
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