Jack Richard Martin, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Practice address

1601 East Main Street
Suite 1B
St Charles, IL 60174

Phone

(630) 377-4955

Fax

(630) 377-4958

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• IL HMO C-SNP
• devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
• devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
• IL PPO Downstate
• devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Martin Chiropractic Clinic LTD

  • Chiropractor
  • St Charles, IL
  • NPI 1851580153
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195516800000",
    "number": "1003914342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WEST SOUTH STREET",
            "address_2": "SUITE 5B",
            "city": "ELBURN",
            "state": "IL",
            "postal_code": "60119",
            "telephone_number": "630-661-1026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 EAST MAIN STREET",
            "address_2": "SUITE 1B",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "60174",
            "telephone_number": "630-377-4955",
            "fax_number": "630-377-4958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JACK",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "4532187",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melinda Marqui, DC, RN, CDCES
• Jacqueline Ann Marshall, L.C.S.W.
• Martin Chiropractic Clinic LTD
• Brett R Martin, D. C.
• Erin Elizabeth Martin
• Mary Ellen Martin, PT
• Sarah Martinez
• Alyssa Ann Martire, M.S CCC-SLP
• John C Mason, DDS
• Michael Masoncup, D.D.S

• Chiropractor in St Charles, IL
• Providers in St Charles, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.