=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548708092
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTYN THOMAS DIP.AC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2017
-----------------------------------------------------
Last Update Date | 02/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 COMPTON RD UNIT 24
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45231-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-521-5333
-----------------------------------------------------
Fax | 513-521-5334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 COMPTON RD UNIT 24
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45231-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-521-5333
-----------------------------------------------------
Fax | 513-521-5334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 65.000032
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------