Provider Demographics
NPI:1699878967
Name:MARTIN, RON R (DC)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:R
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 1:1216 SUNCAST LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9668
Mailing Address - Country:US
Mailing Address - Phone:916-933-8100
Mailing Address - Fax:916-933-7356
Practice Address - Street 1:1216 SUNCAST LN
Practice Address - Street 2:SUITE2
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9668
Practice Address - Country:US
Practice Address - Phone:916-933-8100
Practice Address - Fax:916-933-7356
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0220730Medicare ID - Type Unspecified
CAU36714Medicare UPIN