Provider Demographics
NPI:1467227694
Name:MARTINEZ, KYARA (DC)
Entity type:Individual
Prefix:
First Name:KYARA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9216 CASTORIAN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-4368
Mailing Address - Country:US
Mailing Address - Phone:787-391-0353
Mailing Address - Fax:
Practice Address - Street 1:4747 S HULEN ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1413
Practice Address - Country:US
Practice Address - Phone:682-708-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor