Healthcare Provider Details

I. General information

NPI: 1962627836
Provider Name (Legal Business Name): JANICE SUSAN MARTH L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2158 ATWOOD AVE
MADISON WI
53704-5464
US

IV. Provider business mailing address

1901 MANLEY ST
MADISON WI
53704-3321
US

V. Phone/Fax

Practice location:
  • Phone: 608-215-3058
  • Fax:
Mailing address:
  • Phone: 608-215-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number420-055
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: