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General NPI Number Information
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NPI Number | 1750389656
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Entity Type | Individual
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Provider Name | MATTHEW D MARTI D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 2126 N BLOOMINGTON ST SUITE 1
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City | STREATOR
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State | IL
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Zip | 61364-1394
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Country | US
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Telephone | 815-672-2176
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Fax | 815-672-2177
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Provider Business Mailing Address
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Address Line | 902 POLK ST
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City | STREATOR
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State | IL
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Zip | 61364-1926
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Country | US
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Telephone | 815-672-2176
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Fax | 815-672-2177
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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 | 038008513
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License Number State | IL
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