Provider Demographics
NPI:1215925813
Name:MARTIN, SCOTT W (DC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:W
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 1:8444 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1914
Mailing Address - Country:US
Mailing Address - Phone:323-753-2488
Mailing Address - Fax:323-753-2186
Practice Address - Street 1:8444 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-1914
Practice Address - Country:US
Practice Address - Phone:323-753-2488
Practice Address - Fax:323-753-2186
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC16613Medicare ID - Type Unspecified
T18374Medicare UPIN