MEDICARE: DR. DAVID LUGENE MARTIN D.C.

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	DC 20526	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1841303229	OTHER	CA	NPPES

General Provider Information

NPI Number	:	1215267380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LUGENE MARTIN D.C.

Provider Business Mailing Address
First Line	:	13801 ROSWELL AVE STE F
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5466
Country	:	US
Telephone Number	:	909-591-2525
Fax Number	:	909-464-9797

Provider Business Practice Location Address
First Line	:	13801 ROSWELL AVE STE F
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5466
Country	:	US
Telephone Number	:	909-591-2525
Fax Number	:	909-464-9797

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

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	06/25/2012

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