MEDICARE: DR. MARTY JO LAUDIG 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	DC28810	CA

General Provider Information

NPI Number	:	1932191871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTY JO LAUDIG D.C.

Provider Business Mailing Address
First Line	:	2170 LOMITA BLVD
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-1623
Country	:	US
Telephone Number	:	310-530-1659
Fax Number	:	310-872-5531

Provider Business Practice Location Address
First Line	:	2170 LOMITA BLVD
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-1623
Country	:	US
Telephone Number	:	310-530-1659
Fax Number	:	310-872-5531

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	10/20/2012

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