Individual
SHANE G MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3800 S MOORLAND RD, NEW BERLIN, WI 53151-5226
(262) 271-1505
Mailing address
140 COOK ST, WAUKESHA, WI 53186-4933
(262) 271-1505
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5624-12
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85-1974635
—
WI
Enumeration date
03/02/2021
Last updated
09/18/2023
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