MEDICARE: DR. GENE 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	17685	CA
2	111N00000X	Chiropractor	X004889	NY

General Provider Information

NPI Number	:	1336267889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GENE MARTIN D.C.

Provider Business Mailing Address
First Line	:	520 S EL CAMINO REAL
Second Line	:	SUITE 520
City	:	SAN MATEO
State	:	CA
Zip	:	94402
Country	:	US
Telephone Number	:	650-558-1010
Fax Number	:	650-558-1019

Provider Business Practice Location Address
First Line	:	520 S EL CAMINO REAL
Second Line	:	SUITE 520
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1726
Country	:	US
Telephone Number	:	650-558-1010
Fax Number	:	650-558-1019

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/09/2007

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