MEDICARE: MR. SCOTT W MARTIN 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	DC16613	CA

General Provider Information

NPI Number	:	1215925813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT W MARTIN DC

Provider Business Mailing Address
First Line	:	8444 CRENSHAW BLVD
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90305-1914
Country	:	US
Telephone Number	:	323-753-2488
Fax Number	:	323-753-2186

Provider Business Practice Location Address
First Line	:	8444 CRENSHAW BLVD
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90305-1914
Country	:	US
Telephone Number	:	323-753-2488
Fax Number	:	323-753-2186

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	08/31/2010

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