MEDICARE: DR. ANGELA MARIA DIMARTINO 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	2301008537	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386660421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA MARIA DIMARTINO DC

Provider Business Mailing Address
First Line	:	30120 23 MILE RD
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48047-2190
Country	:	US
Telephone Number	:	586-949-9248
Fax Number	:	586-949-6048

Provider Business Practice Location Address
First Line	:	30120 23 MILE RD
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48047-2190
Country	:	US
Telephone Number	:	586-949-9248
Fax Number	:	586-949-6048

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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