Individual
DR. JACK RICHARD MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1601 EAST MAIN STREET, SUITE 1B, ST CHARLES, IL 60174
(630) 377-4955
(630) 377-4958
Mailing address
200 WEST SOUTH STREET, SUITE 5B, ELBURN, IL 60119
(630) 661-1026
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4532187
BC/BS
IL
Enumeration date
09/20/2006
Last updated
11/20/2007
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