MEDICARE: MARTIN CHIROPRACTIC AND INJURY CENTER

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	DC22073	CA

General Provider Information

NPI Number	:	1275769309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN CHIROPRACTIC AND INJURY CENTER

Provider Business Mailing Address
First Line	:	1216 SUNCAST LN
Second Line	:	SUITE #2
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9668
Country	:	US
Telephone Number	:	916-933-8100
Fax Number	:	916-933-7356

Provider Business Practice Location Address
First Line	:	1216 SUNCAST LN
Second Line	:	SUITE #2
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9668
Country	:	US
Telephone Number	:	916-933-8100
Fax Number	:	916-933-7356

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RON R MARTIN
Credential	:	D.C.
Telephone Number	:	916-933-8100

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	06/03/2009

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