MEDICARE: DR. MIGUEL F MARTINEZ DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X008100	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033197702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL F MARTINEZ DC

Provider Business Mailing Address
First Line	:	20507 HILLSIDE AVE
Second Line	:	SUITE 19
City	:	HOLLIS
State	:	NY
Zip	:	11423-2220
Country	:	US
Telephone Number	:	718-468-1234
Fax Number	:	718-468-4003

Provider Business Practice Location Address
First Line	:	20507 HILLSIDE AVE
Second Line	:	SUITE 19
City	:	HOLLIS
State	:	NY
Zip	:	11423-2220
Country	:	US
Telephone Number	:	718-468-1234
Fax Number	:	718-468-4003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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