MEDICARE: LAUREN E 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	12350	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12666069	OTHER		CAQH
2	8EC958	OTHER	TX	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1295168714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN E MARTIN D.C.

Provider Business Mailing Address
First Line	:	6825 STEWART RD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-1841
Country	:	US
Telephone Number	:	409-744-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	6825 STEWART RD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-1841
Country	:	US
Telephone Number	:	409-744-2225
Fax Number	:

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

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	07/01/2014

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Directions to “ LAUREN E MARTIN D.C.” Practice Location

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