Provider Demographics
NPI:1104884675
Name:MARTIN, TIMOTHY F (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:F
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 1:2525 W CAREFREE HWY
Mailing Address - Street 2:BLD 1 SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:623-587-0277
Mailing Address - Fax:623-587-0277
Practice Address - Street 1:1500 E CEDAR AVE
Practice Address - Street 2:SUITE 80
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004
Practice Address - Country:US
Practice Address - Phone:928-522-8459
Practice Address - Fax:928-522-8462
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
67587Medicare ID - Type Unspecified
U62219Medicare UPIN