Provider Demographics
NPI:1861798761
Name:CASTRO, MARTINA THEODORA (DC)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:THEODORA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 COSTA VERDE CT
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2188
Mailing Address - Country:US
Mailing Address - Phone:573-268-0872
Mailing Address - Fax:
Practice Address - Street 1:350D RACETRACK RD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1699
Practice Address - Country:US
Practice Address - Phone:850-837-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor