Healthcare Provider Details

I. General information

NPI: 1801705959
Provider Name (Legal Business Name): MARTIN MILLER MAC, LAC, DIP OM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MEADOW DR
WINDSOR CA
95492-9665
US

IV. Provider business mailing address

129 MEADOW DR
WINDSOR CA
95492-9665
US

V. Phone/Fax

Practice location:
  • Phone: 707-326-4230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: