MEDICARE: HOWARD SAMUEL 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	DC25254	CA

General Provider Information

NPI Number	:	1629143631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOWARD SAMUEL MARTIN D.C.

Provider Business Mailing Address
First Line	:	2128 FERRELL AVE
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-3227
Country	:	US
Telephone Number	:	805-772-2201
Fax Number	:

Provider Business Practice Location Address
First Line	:	2128 FERRELL AVE
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-3227
Country	:	US
Telephone Number	:	805-772-2201
Fax Number	:

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	11/04/2016

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