Organization
GREAT LAKES SPORT AND SPINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW PAUL MARTIN DC (OWNER)
(440) 503-6683
Entity
Organization
Contact information
Practice address
34940 RIDGE RD STE B, WILLOUGHBY, OH 44094-4197
(440) 503-6683
Mailing address
34940 RIDGE RD STE B, WILLOUGHBY, OH 44094-4197
(440) 503-6683
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
171100000X
Acupuncturist
—
—
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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