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General NPI Number Information
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NPI Number | 1275769309
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Entity Type | Organization
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Legal Business Name | MARTIN CHIROPRACTIC AND INJURY CENTER
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 1216 SUNCAST LN SUITE #2
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-9668
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Country | US
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Telephone | 916-933-8100
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Fax | 916-933-7356
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Provider Business Mailing Address
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Address Line | 1216 SUNCAST LN SUITE #2
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-9668
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Country | US
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Telephone | 916-933-8100
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Fax | 916-933-7356
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RON R MARTIN
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Credential | D.C.
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Telephone | 916-933-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC22073
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License Number State | CA
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