1548570047 NPI number — DR. MATTHEW WALTER MARTINEZ D.C

Table of content: DR. MATTHEW WALTER MARTINEZ D.C (NPI 1548570047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548570047 NPI number — DR. MATTHEW WALTER MARTINEZ D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
MATTHEW
Provider Middle Name:
WALTER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C
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:
1548570047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 BRISTOL CT SW
Provider Second Line Business Mailing Address:
SUITE A-102
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98502-6003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-350-0539
Provider Business Mailing Address Fax Number:
360-539-7336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 BRISTOL CT SW
Provider Second Line Business Practice Location Address:
SUITE A-102
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98502-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-350-0539
Provider Business Practice Location Address Fax Number:
360-539-7336
Provider Enumeration Date:
10/18/2010

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:  CH60191433 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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