Organization Active NPI

Martinsville Chiropractic Center, Inc.

  • Chiropractor
  • Martinsville, VA
National Provider Identifier
1164529376
Registry record updated Oct 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104000930 Issued in VA
Legal business name
MARTINSVILLE CHIROPRACTIC CENTER, INC.
Practice address
425 Commonwealth Blvd E
Martinsville, VA 24112-2014
Phone
(276) 632-2226
Fax
(276) 632-2395
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2012

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

Authorized official

Name
Dr. Glenn M Stark, D.C.
Title
President/D.C.
Phone
(276) 632-2226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 0104000930 VA Primary

Addresses

Primary practice location

425 Commonwealth Blvd E
Martinsville, VA 24112-2014

Mailing address

425 Commonwealth Blvd E
Martinsville, VA 24112-2014
Phone (276) 632-2226

Other identifiers 1

IdentifierTypeStateIssuer
008922110MedicaidVA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1164529376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 COMMONWEALTH BLVD E",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241122014",
            "telephone_number": "276-632-2226",
            "fax_number": "276-632-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 COMMONWEALTH BLVD E",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241122014",
            "telephone_number": "276-632-2226",
            "fax_number": "276-632-2395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTINSVILLE CHIROPRACTIC CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/D.C.",
        "authorized_official_telephone_number": "276-632-2226",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104000930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008922110",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinsville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.