Provider Demographics
NPI:1568271252
Name:GARY R. MARTIN, D.C., CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:GARY R. MARTIN, D.C., CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-559-7999
Mailing Address - Street 1:4330 BARRANCA PKWY STE 150B
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1704
Mailing Address - Country:US
Mailing Address - Phone:949-559-7999
Mailing Address - Fax:949-559-8097
Practice Address - Street 1:4330 BARRANCA PKWY STE 150B
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1704
Practice Address - Country:US
Practice Address - Phone:949-559-7999
Practice Address - Fax:949-559-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty