Individual
DR. PAUL TIMOTHY MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
9040 MILLBRANCH RD, SOUTHAVEN, MS 38671-1420
(662) 342-1107
(662) 280-0178
Mailing address
9040 MILLBRANCH RD, SOUTHAVEN, MS 38671-1420
(662) 342-1107
(662) 280-0178
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
754
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0123504
BC/TN
TN
01
—
4350351
AETNA
MS
01
—
6443272001
CIGNA
MS
Enumeration date
10/04/2006
Last updated
01/23/2012
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