Provider Demographics
NPI:1831234996
Name:MARTIN, TROY B (DC)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10612 CLEMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-4543
Mailing Address - Country:US
Mailing Address - Phone:864-643-5505
Mailing Address - Fax:864-985-0095
Practice Address - Street 1:10612 CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4543
Practice Address - Country:US
Practice Address - Phone:864-643-5505
Practice Address - Fax:864-985-0095
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9562111N00000X
DEF1-0000821111N00000X
SC2608111N00000X
SCSC2608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU864477351Medicare UPIN
SC7351Medicare ID - Type Unspecified