Provider Demographics
NPI:1306449657
Name:MARTINKO, JAMIE NICOLE (DC, ATC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICOLE
Last Name:MARTINKO
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W MASON ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:MO
Mailing Address - Zip Code:64076-1262
Mailing Address - Country:US
Mailing Address - Phone:816-533-5867
Mailing Address - Fax:
Practice Address - Street 1:213 W MASON ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:MO
Practice Address - Zip Code:64076-1262
Practice Address - Country:US
Practice Address - Phone:816-533-5867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020036035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor