MEDICARE: EDWARD L MARTIN PC

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	2301006823	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0G31168	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1477693398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD L MARTIN PC

Provider Business Mailing Address
First Line	:	5905 W ROLLING HILLS DR
Second Line	:
City	:	BRIDGEPORT
State	:	MI
Zip	:	48722-9656
Country	:	US
Telephone Number	:	989-777-8282
Fax Number	:	989-777-8680

Provider Business Practice Location Address
First Line	:	5905 W ROLLING HILLS DR
Second Line	:
City	:	BRIDGEPORT
State	:	MI
Zip	:	48722-9656
Country	:	US
Telephone Number	:	989-777-8282
Fax Number	:	989-777-8680

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD L MARTIN
Credential	:	DC
Telephone Number	:	989-777-8282

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/02/2009

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Directions to “EDWARD L MARTIN PC ” Practice Location

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