MEDICARE: MR. THOMAS J MARTIN LAC

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	171100000X	Acupuncturist	AC00282	OR

General Provider Information

NPI Number	:	1457397895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS J MARTIN LAC

Provider Business Mailing Address
First Line	:	2144 SE 54TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97215-3920
Country	:	US
Telephone Number	:	503-784-7021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 DIVISION ST
Second Line	:	OREGON CITY WELLNESS & FAMILY MEDICINE
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1521
Country	:	US
Telephone Number	:	503-655-5327
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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