MEDICARE: DR. AMANDA STARR 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	3130	SC

General Provider Information

NPI Number	:	1609099829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA STARR MARTIN D.C.

Provider Business Mailing Address
First Line	:	997 JOHNNIE DODDS BLVD APT 926
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-6120
Country	:	US
Telephone Number	:	843-425-8426
Fax Number	:	843-225-5210

Provider Business Practice Location Address
First Line	:	912 SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7802
Country	:	US
Telephone Number	:	843-225-4080
Fax Number	:	843-225-5210

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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