Provider Demographics
NPI:1053416180
Name:STINE, MARTIN (DC)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:STINE
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 1:400 N MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1417
Mailing Address - Country:US
Mailing Address - Phone:563-324-8888
Mailing Address - Fax:563-324-8888
Practice Address - Street 1:400 N MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1417
Practice Address - Country:US
Practice Address - Phone:563-324-8888
Practice Address - Fax:563-324-8888
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06075111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1811001Medicare UPIN