=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619040144
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID RICHARD MARTIN B.SC., D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 SW 1ST AVE
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-4220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-732-2745
-----------------------------------------------------
Fax | 352-732-8066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1007 SW 1ST AVE
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-4220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-732-2745
-----------------------------------------------------
Fax | 352-732-8066
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH9106
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR006551
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------