MEDICARE: DR. MARTIN PAUL FIEDLER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC015919	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083777007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN PAUL FIEDLER DC

Provider Business Mailing Address
First Line	:	PO BOX 298
Second Line	:	9667 HWY 29 STE 101
City	:	LOWER LAKE
State	:	CA
Zip	:	95457
Country	:	US
Telephone Number	:	707-994-6940
Fax Number	:	707-994-6941

Provider Business Practice Location Address
First Line	:	9667 HWY 29
Second Line	:	STE 101
City	:	LOWER LAKE
State	:	CA
Zip	:	95457
Country	:	US
Telephone Number	:	707-994-6940
Fax Number	:	707-994-6941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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