Provider Demographics
NPI:1215919832
Name:MARTIN, WILLIAM (DC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
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 1:1015 CONGDON AVE
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1117
Mailing Address - Country:US
Mailing Address - Phone:570-421-2977
Mailing Address - Fax:570-421-7084
Practice Address - Street 1:1015 CONGDON AVE
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1117
Practice Address - Country:US
Practice Address - Phone:570-421-2977
Practice Address - Fax:570-421-7084
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T72793Medicare UPIN
404714Medicare ID - Type Unspecified