Basic Information
| Provider Information | |||||||||
| NPI: | 1114436862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | WADE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17330 PRESTON RD. | ||||||||
| Address2: | SUITE 150A | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727891234 | ||||||||
| FaxNumber: | 9727891589 | ||||||||
| Practice Location | |||||||||
| Address1: | 17330 PRESTON RD. | ||||||||
| Address2: | SUITE 150A | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727891234 | ||||||||
| FaxNumber: | 9727891589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2017 | ||||||||
| LastUpdateDate: | 09/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 8411 | TX | Y | Chiropractic Providers | Chiropractor |
No ID Information.