Provider Demographics
NPI:1073342564
Name:MARTELL, ELIEZER
Entity type:Individual
Prefix:
First Name:ELIEZER
Middle Name:
Last Name:MARTELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 DUNLAWTON AVE APT 3513
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-7932
Mailing Address - Country:US
Mailing Address - Phone:787-629-3306
Mailing Address - Fax:
Practice Address - Street 1:940 CENTRE CIR STE 1018
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7242
Practice Address - Country:US
Practice Address - Phone:407-789-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor