Provider Demographics
NPI:1194497685
Name:MARTIN, NICHOLAUS ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAUS
Middle Name:ALLEN
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 1:1800 COOPER POINT RD SW STE 24A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1039
Mailing Address - Country:US
Mailing Address - Phone:360-623-2237
Mailing Address - Fax:
Practice Address - Street 1:1800 COOPER POINT RD SW STE 24A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1039
Practice Address - Country:US
Practice Address - Phone:360-940-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61218402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor