Provider Demographics
NPI:1992720171
Name:MARTINI, DALE (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:
Last Name:MARTINI
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 1:988 N WINSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8760
Mailing Address - Country:US
Mailing Address - Phone:252-443-5177
Mailing Address - Fax:252-443-7914
Practice Address - Street 1:988 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8760
Practice Address - Country:US
Practice Address - Phone:252-443-5177
Practice Address - Fax:252-443-7914
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
56-2243185OtherTAX ID
NC890837PMedicaid
NC890837PMedicaid