Provider Demographics
NPI:1871742353
Name:PETER MARTIN CHIROPRACTIC OFFICES PC
Entity type:Organization
Organization Name:PETER MARTIN CHIROPRACTIC OFFICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:929-268-4316
Mailing Address - Street 1:10620 SHORE FRONT PKWY
Mailing Address - Street 2:APT 12H
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2639
Mailing Address - Country:US
Mailing Address - Phone:929-268-4316
Mailing Address - Fax:
Practice Address - Street 1:10620 SHORE FRONT PKWY
Practice Address - Street 2:SUITE 12H
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2639
Practice Address - Country:US
Practice Address - Phone:929-268-4316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX007467OtherLICENSE
X90141Medicare UPIN