Organization Active NPI

Martin Blanchard Jr., D.C., PLLC

  • Chiropractor
  • Tyler, TX
National Provider Identifier
1356687206
Registry record updated Dec 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2308 Issued in TX
Legal business name
MARTIN BLANCHARD JR., D.C., PLLC
Practice address
3816 Southpark Dr
Tyler, TX 75703-1713
Phone
(903) 561-0372
Fax
(903) 561-0463
NPI assigned
Dec 21, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2012

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

Authorized official

Name
Martin Blanchard Jr., DC PLLCNPI 1134165236
Title
Owner
Phone
(903) 561-0372

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2308 TX Primary

Addresses

Primary practice location

3816 Southpark Dr
Tyler, TX 75703-1713

Mailing address

3816 Southpark Dr
Tyler, TX 75703-1713
Phone (903) 561-0372

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130531000152 TX Part B Supplier - Clinic/Group Practice 2264670348 Receives reassigned benefits from 1 practitioner
Practice locations: Tyler, TX

National Provider Directory

National Provider Directory

Locations

3816 Southpark Dr
Tyler, TX 75703
Phone (903) 561-0372

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": "1356048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356048000000",
    "number": "1356687206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3816 SOUTHPARK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031713",
            "telephone_number": "903-561-0372",
            "fax_number": "903-561-0463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3816 SOUTHPARK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031713",
            "telephone_number": "903-561-0372",
            "fax_number": "903-561-0463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN BLANCHARD JR., D.C., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-21",
        "last_updated": "2012-12-21",
        "status": "A",
        "authorized_official_last_name": "BLANCHARD",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-561-0372",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DC PLLC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "2308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.