MEDICARE: DR. TERRY H MARTIN D.C.P.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	161807-1202	UT

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	:	1447224720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY H MARTIN D.C.P.C.

Provider Business Mailing Address
First Line	:	1951 W 4700 S STE 1
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84118-1108
Country	:	US
Telephone Number	:	801-969-8197
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 W 4700 S STE 1
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84118-1108
Country	:	US
Telephone Number	:	801-969-8197
Fax Number	:

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	08/27/2007

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