Provider Demographics
NPI:1871556654
Name:MARTIN, BLAIR A (DC)
Entity type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:A
Last Name:MARTIN
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 1:163-D BLUFFTON ROAD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910
Mailing Address - Country:US
Mailing Address - Phone:843-757-4100
Mailing Address - Fax:843-757-6932
Practice Address - Street 1:163-D BLUFFTON ROAD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-757-4100
Practice Address - Fax:843-757-6932
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1846111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU537000282Medicare ID - Type Unspecified