Provider Demographics
NPI:1962424143
Name:MARTINEZ, THEODORE JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JOSEPH
Last Name:MARTINEZ
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 1:3985 N FRESNO ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4000
Mailing Address - Country:US
Mailing Address - Phone:559-230-0477
Mailing Address - Fax:559-230-0478
Practice Address - Street 1:3985 N FRESNO ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4000
Practice Address - Country:US
Practice Address - Phone:559-230-0477
Practice Address - Fax:559-230-0478
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19531111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0195311Medicare ID - Type Unspecified