Provider Demographics
NPI:1053752246
Name:MARTINEZ, JORGE ANTONIO (DC)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ANTONIO
Last Name:MARTINEZ
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 1:14770 MEMORIAL DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5252
Mailing Address - Country:US
Mailing Address - Phone:281-493-5535
Mailing Address - Fax:281-493-3353
Practice Address - Street 1:13259 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5812
Practice Address - Country:US
Practice Address - Phone:713-330-1530
Practice Address - Fax:713-330-1535
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor