MEDICARE: DR. ALLISE A MARTER 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	X003625-1	NY

General Provider Information

NPI Number	:	1235122540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISE A MARTER DC

Provider Business Mailing Address
First Line	:	38 N MAIN ST
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-1017
Country	:	US
Telephone Number	:	845-647-5430
Fax Number	:	845-647-1195

Provider Business Practice Location Address
First Line	:	38 N MAIN ST
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-1017
Country	:	US
Telephone Number	:	845-647-5430
Fax Number	:	845-647-1195

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. ALLISE A MARTER DC” Practice Location

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