1104884675 NPI number — DR. TIMOTHY F MARTIN DC

Table of content: DR. TIMOTHY F MARTIN DC (NPI 1104884675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104884675 NPI number — DR. TIMOTHY F MARTIN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
TIMOTHY
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104884675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 W CAREFREE HWY
Provider Second Line Business Mailing Address:
BLD 1 SUITE 100
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-587-0277
Provider Business Mailing Address Fax Number:
623-587-0277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 E CEDAR AVE
Provider Second Line Business Practice Location Address:
SUITE 80
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-522-8459
Provider Business Practice Location Address Fax Number:
928-522-8462
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5518 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com