Provider Demographics
NPI:1699907170
Name:MARTIN, MICHAEL T (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:907 EL DORADO BLVD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062
Mailing Address - Country:US
Mailing Address - Phone:281-488-2291
Mailing Address - Fax:281-402-1980
Practice Address - Street 1:907 EL DORADO BLVD.
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062
Practice Address - Country:US
Practice Address - Phone:281-488-2291
Practice Address - Fax:281-402-1980
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor