MEDICARE: DR. MARTIN JOHN CODINO D.C.

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	2841	OR

General Provider Information

NPI Number	:	1457419889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN JOHN CODINO D.C.

Provider Business Mailing Address
First Line	:	4317 NE TILLAMOOK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1315
Country	:	US
Telephone Number	:	503-493-9730
Fax Number	:	503-493-1642

Provider Business Practice Location Address
First Line	:	4317 NE TILLAMOOK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1315
Country	:	US
Telephone Number	:	503-493-9730
Fax Number	:	503-493-1642

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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