MEDICARE: DR. JOHN ANTHONY MARTIN 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	23904	CA

General Provider Information

NPI Number	:	1588726137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ANTHONY MARTIN DC

Provider Business Mailing Address
First Line	:	225 WASHINGTON ST STE B-1
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-5975
Country	:	US
Telephone Number	:	408-249-7767
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 WASHINGTON ST STE B-1
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-5975
Country	:	US
Telephone Number	:	408-249-7767
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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