=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457495863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEAN L. MARTIN, D.C.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2007
-----------------------------------------------------
Last Update Date | 09/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1083 VIOLET AVE
-----------------------------------------------------
City | HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12538-1681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-229-2225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1083 VIOLET AVE
-----------------------------------------------------
City | HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12538-1681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-229-2225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SEAN L. MARTIN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 845-229-2225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X010106
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------