Provider Demographics
NPI:1861518524
Name:MICHAEL C. MARTIN D.C. P.A.
Entity type:Organization
Organization Name:MICHAEL C. MARTIN D.C. P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-282-5411
Mailing Address - Street 1:1228 PRECINCT LINE RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4290
Mailing Address - Country:US
Mailing Address - Phone:817-282-5411
Mailing Address - Fax:817-282-5438
Practice Address - Street 1:1228 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4290
Practice Address - Country:US
Practice Address - Phone:817-282-5411
Practice Address - Fax:817-282-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2992111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770594517OtherNPI (INDIVIDUAL)
TX2992OtherSTATE LICENSE
TX0018MNOtherBLUE CROSS BLUE SHIELD
TX2992OtherSTATE LICENSE