Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 7612 | AZ |
N | 111NN1001X | Nutrition | 7612 | AZ |
Y | 111NN1001X | Nutrition | CHR-6494 | CO |
NPI | 1437282647 |
---|---|
Provider Name | Dr. Kristopher Martin |
First Address | Denver, CO 80237-1360 |
Second Address | Denver, CO 80237-1360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 20/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AZ0155500 | BLUECROSS (01) | AZ |
V07421 | (02) | AZ |