MEDICARE: DR. KENNETH EDWARD 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	DC11476	CA

General Provider Information

NPI Number	:	1528057726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH EDWARD MARTIN D.C.

Provider Business Mailing Address
First Line	:	9130 LAS TUNAS DR
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1903
Country	:	US
Telephone Number	:	626-286-8200
Fax Number	:	626-286-7552

Provider Business Practice Location Address
First Line	:	9130 LAS TUNAS DR
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1903
Country	:	US
Telephone Number	:	626-286-8200
Fax Number	:	626-286-7552

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	05/26/2009

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