MEDICARE: DR. JUAN MARTINEZ JR. 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	01-05475	KS

General Provider Information

NPI Number	:	1306107818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN MARTINEZ JR. DC

Provider Business Mailing Address
First Line	:	1999 N AMIDON AVE STE 224
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-2123
Country	:	US
Telephone Number	:	316-838-8883
Fax Number	:	316-831-9233

Provider Business Practice Location Address
First Line	:	1999 N AMIDON AVE STE 224
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-2123
Country	:	US
Telephone Number	:	316-838-8883
Fax Number	:	316-831-9233

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

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	05/31/2012

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