Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 0104000719 | VA |
NPI | 1356353122 |
---|---|
Provider Name | Dr. Jeffrey Lloyd Martin |
First Address | Midlothian, VA 23112-3205 |
Second Address | Midlothian, VA 23112-3205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 20/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107761 | ANTHEM PROVIDER ID (01) | VA |
T78325 | (02) | VA |