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General NPI Number Information
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NPI Number | 1477811750
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Entity Type | Organization
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Legal Business Name | LOGAN C MARTIN PC
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 1019 W LACROSSE AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2418
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Country | US
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Telephone | 208-292-4873
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Fax | 208-292-4875
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Provider Business Mailing Address
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Address Line | 1911 N QUAIL RUN BLVD
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City | POST FALLS
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State | ID
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Zip | 83854-6018
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Country | US
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Telephone | 208-292-4873
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Fax | 208-292-4875
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LOGAN C MARTIN
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Credential | D.C.
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Telephone | 208-292-4873
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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 | CHIA-1192
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License Number State | ID
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