Provider Demographics
NPI:1104973007
Name:KATZ, DAVID MARTIN (DC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARTIN
Last Name:KATZ
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 1:6914 COVINGTON CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2962
Mailing Address - Country:US
Mailing Address - Phone:248-352-5851
Mailing Address - Fax:248-352-5812
Practice Address - Street 1:26561 W 12 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1541
Practice Address - Country:US
Practice Address - Phone:248-352-5851
Practice Address - Fax:248-352-5812
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDK005781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N56120Medicare ID - Type Unspecified
U38794Medicare UPIN