Provider Demographics
NPI:1114467438
Name:MARTIN, SANDRA P (DC, LLC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:P
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4778 CLOVERLAWN DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-218-5037
Mailing Address - Fax:541-474-5918
Practice Address - Street 1:4778 CLOVERLAWN DRIVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-218-5037
Practice Address - Fax:541-474-5918
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor