MEDICARE: JAMES D MARTIN D.C., C.C.S.P.

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	111NS0005X	Sports Physician Chiropractor	AA187	AK

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	:	1396724951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES D MARTIN D.C., C.C.S.P.

Provider Business Mailing Address
First Line	:	400 N MAIN ST
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7018
Country	:	US
Telephone Number	:	907-373-2022
Fax Number	:	907-373-2029

Provider Business Practice Location Address
First Line	:	400 N MAIN ST
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7018
Country	:	US
Telephone Number	:	907-373-2022
Fax Number	:	907-373-2029

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	07/08/2007

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